The Person-centred Approach of Individuals with Dementia

1.1

The person-centred approach means focusing on the individual’s personal wellbeing and needs, along with their wants, desires and goals. A person-centred care approach is used to involve a strong interest in the patient’s own experience of health, illness, injury or need. Ways to ensure a person-centred care approach include;

• knowing the patient as an individual
• being responsive
• providing care that is meaningful
• respecting the individual’s values, preferences and needs
• fostering trusting caregiving relationships
• emphasising freedom of choice
• promoting physical and emotional comfort
• involving the person’s family and friends, as appropriate.

1.2

The benefits of working with an individual with dementia in a person-centred approach include reduced agitation. There were studies done including 3,985 participants, 17 of these studies were in long-term care facilities and 2 studies were in homecare settings. The studies analysed the greater effectiveness of person-centred care when implemented for persons with dementia. The person-centred care approach has been shown to also reduce neuropsychiatric symptoms, depression and quality of life. However, the effectiveness varies depending on the severity of the dementia. Using a person-centred care approach can also help the carers to get to know the person they’re caring for better, by collecting information of their life history, to generally understanding who the person is. This all helps promote a good quality of life and wellbeing for the individual with dementia. Other benefits include fewer falls and an increased participation in tasks. The person-centred care approach is not only benefiting the individual being cared for but all benefiting the carer. Studies show that staff using this approach after having intensive training, experience less stress, burnout and job dissatisfaction. The training received by carers helped them better connect with their patients and enjoy rewarding work experiences. Overall the person-centred care approach benefits both carer and the individual being cared for.

2.1

The role that carers have in supporting individuals with dementia is crucially important. Carers enable a person with dementia to have a good quality of life and live well throughout their experience with the disability. Carers can be anyone from close family to hospital nurses. The carers involvement helps the individual retain a sense of identity and belonging. Carers have a role in supporting the individual to maintain skills, abilities and an active social life which can support how they feel about themselves. Everyday tasks a carer will help with include;

• shopping
• laying the table
• gardening
• taking the dog for a walk

Whereas in an assisted living facility, hospital or a facility where the persons dementia is severe, the carers will help with various other tasks such as medication, washing and bathing, using the toilet, etc. Carers also have a role in helping them with eating and drinking. It is important for a person with dementia to keep a well-balanced diet and lifestyle, however not drinking enough can put them at risk for infection, constipation and headaches. The carer also has a responsibility to create a less stressful environment for them as they might become confused or agitated. Memory loss is a huge symptom of dementia and therefore the person won’t remember their last meal, wash, medication, etc. These are all responsibilities for the carers. Carers may work with several groups of professionals who may be involved with planning care (not just the key person). Their knowledge and expertise concerning the individual needing care will be valued by these different groups of health and social care professionals, as this knowledge will ensure the relative remains knowledge to any decisions made about their care.

2.2

Developing and maintaining good relationships is vital to improving outcomes for individuals and their families. The carers role is to create an environment in which people feel comfortable and their needs are being heard and understood. The carer requires skills in honesty and integrity. A professional relationship with the carer should be founded on openness, transparency and empathy. When caring for an individual with dementia the family must feel that they are happy with the carer and trust the carer with their loved ones needs and wellbeing. It is important that the carer facilitate participation in decision making and meaningful activities. The caring professional is responsible for establishing and    maintaining a meaningful and effective professional relationship with the individual, based upon an understanding of their individual needs and preferences in relating to others. Developing positive professional relationships with carers is essential for ensuring effective partnership working, both with individuals who require care and support, and with all those involved in their lives such as their advocates, families, friends, professionals and managers. Creating environments that are safe/comfortable places for those who attend, live or work in them and where a sense of well-being is promoted is vital to delivering high-quality, safe, effective and compassionate care and support.

3.1

Family, friends had a huge role in the individual’s life before dementia and even more so now that they have the disability. They are becoming more co-dependent and their emotions and wellbeing is significantly more affected by the attitudes and behaviours of those around them. The role of the family and friends for an individual with dementia is emotional support, understanding and maintaining identity. However, the roles of the health care professionals in the care and support of someone with dementia is different. There are many different types of doctors with different roles and these include;

• Consultants

Consultants are doctors who have had years of training and experience in a particular area. Some will arrange for investigations, such as brain scans, and be able to start prescribing of drugs for dementia.

• Psychiatrists

Psychiatrists diagnose and treat many different mental health problems, including dementia, but also depression, anxiety and others. You might see an old-age psychiatrist, who has specialised in treating older people.

• Geriatricians,

Geriatricians specialise in the care of older people, and in the physical illnesses and disabilities of old age.

• Neurologists

Neurologists specialise in the brain and nervous system. Some neurologists have particular experience in dementia, particularly types like dementia with Lewy bodies and Parkinson’s disease dementia.

• Clinical psychologists

Clinical psychologists are not medical doctors. They assess memory, learning abilities and other skills. They also offer support to cope with any difficulties you may be experiencing, such as anxiety or mental distress. They often work with consultants in memory clinics as part of a team.

The general role of the doctor with the support and care of an individual with dementia involves;

• talking to you about your symptoms and medical problems (not just dementia)
• carrying out a physical examination
• arranging further tests with a consultant or hospital specialist
• reviewing whether your drugs are working

Furthermore, the role of nurses differs based of the type of nurse. For example, a Community mental health nurse (CPN) provides treatment, care and support for mental health problems, they might assess the individual at home and give advice. The role of the district or community nurse is with tasks such as taking medication and dressing wounds. Practice nurses carry out a range of nursing activities such as flu jabs and check-ups. They also have the role of carrying out general treatments (dressings and injections) along with looking after patients with ongoing illnesses. Finally, admiral nurses specialise in dementia care and can support the individual and their carer.

Other healthcare professionals include;

• Occupational therapists

Occupational therapists (often called OTs) can advise you on how to maintain skills and live independently for as long as possible. They can also advise about assistive technology ‘gadgets’ as well as about equipment and adaptations the individual’s home.

• Physiotherapists

Physiotherapists can advise on exercise and moving around. They can also advise carers on ways of helping someone to move around safely. Home visits can also be arranged for individuals.

• Chiropodists

Having healthy, pain-free feet will help to keep mobile. A chiropodist is trained to look after people’s feet and advise on proper foot care.

Vision, hearing and speech

• Optometrists

It is important for an individual with dementia to get their eyes checked regularly.

• Audiologists

An audiologist can check for hearing problems and fit a hearing aid, if required.

Speech and language therapists

Speech and language therapists can advise you and your carer on ways of communicating more effectively, and on coping with any swallowing difficulties.

• Music therapists

Music therapists use music to help with symptoms of anxiety or restlessness, or help to express yourself or reminisce. They will engage the individual in a shared musical experience, through singing, listening or making music.

Oral health, nutrition and continence

• Dentists

Provide regular check-ups and provide advice for oral health.

• Dietitians

A dietitian can give advice about what to eat. They can tell you about poor appetite, weight loss, weight gain, vitamins and food supplements. A professionally qualified dietitian will have the letters ‘SRD’ (State Registered Dietitian) after their name.

• Continence advisers

Continence advisers can offer advice with difficulties using the toilet, etc.

3.2

It may be necessary to refer to others when supporting individuals with dementia, when the cares provided inside the dementia nursing home are no longer able to answer the needs of the individual living with dementia. When an individual living with dementia is anxious, dangerously aggressive and violent for the care assistant staffs, when the cares provided inside the dementia nursing home are no longer enough and or cannot longer provide successfully for the needs of the individual living with dementia, then it is time to refer to others. This is why it is very important that the individual living with dementia is referred to the appropriate specialist so that the cares can be assessed and adjusted appropriately to make feel a bit better the individual that suffer of dementia.

3.3

Additional support of others when supporting individuals living with dementia can be accessed through nurses, general practitioners and specialists that have been trained in the disease of dementia. There are also local services that can offer families with dementia the support they need, whether that be practical or emotional. Admiral nurses can support the whole family from diagnosis to end of life. Local support groups are also accessible and are run by charities e.g. Age UK or Alzheimer’s Society.

• https://www.open.edu/openlearn/body-mind/health/nursing/the-importance-person-centred-approaches-nursing-care