Person Centred Approach to Dementia and Geriatric Care

• Ranny Roi P.Gaco

Abstract

This paper examines the different principles involved in the person centred approach to dementia and other common geriatric health condition’s care. It will also tackle the differences against institution perspective approach and bio-medical perspective with respect to the person-centred approach in managing care. This assessment will also be discussing range of techniques used to meet the fluctuating abilities and needs of individuals that are very common to degenerative geriatric health conditions, as well as its impacts to equality and cultural diversity in meeting these issues in public health. This paper will also examine the government’s initiatives and programs available to meet the demands in caring with these types of elderly conditions.

Introduction

Caring comes in different ways as well as techniques in how to be able to provide the best way to our loved ones. While there are institutions who provide the best care for our loved ones, it is often being neglected that the very heart of caring is not just merely providing the basic care that the clients need but also with the quality of care that we are giving to them. Validations of the quality of care are often not being examine and should be given an emphasis especially that the abilities of the elderly with dementia are deteriorating, it is hard for them to feedback the way we are treating them or should the approach of care is the appropriate one they are actually needing.

Question 1

Individuality

We all know that whatever care we are doing, we need to considering the aspect of individuality with respect in caring with people with dementia and other geriatric conditions. In doing so, we can render a care that is suitable to the individual as we all know that every one is unique and so do with respect to caring attitude. Health workers should be conscious and must bear in mind that everyone has the right to be treated with individual needs in relation to person-centred approached that recognises the value, uniqueness of each person, understanding the world from the perspective of the service user, and providing a social environment to every individual under our care.

Rights

Every person is born with each right that no one can take away and must be respected. In dealing with elderly suffering from dementia, these rights are not being taken away and must be respected and are carried out to its highest standards. The health care provider’s role is to assess the patient’s cognitive function in order to plan what should be given to the patient especially that dementia is a condition that is interlinked with different medical conditions. Every time that someone is getting a care, this aspect of principles is being carried out in outmost consideration.

Choice

Choice is connected to individual’s right that whoever receives treatment and care should be given a choice in a way that will be helpful in managing his care. It is also the patient’s choice in instances that a further treatment is being withdrawn or further care shall be ignored. This should be explained properly to them and if cognitive functionality is impaired, the patient has the right to nominate a representative that will decide what suits best for the patient. This is commonly being delegated to the next of kin of the patient or whomever the patient assigns.

Privacy

This principle does apply to everyone and in every industry and so does with respect in managing care to those who are undergoing degenerative diseases. Privacy is being carried out such us the prognosis of the patients and shall not be divulge to anyone except to those who are only part of the team. Even medical research does not automatically be allowed to invade each patient’s medical documents without the consent of the patient. Normally, each institution does have their own ethics committee in dealing with privacy concerns as well as policies in releasing documents that is legally binding between the service provider and the customer. In dealing with procedures that is needed for the patient to undergo, an informed consent must be secured first, provided that the patient will understand the procedure and how beneficial to the client.

Independence

The goal of the care will not be a success if not with the help of the patients themselves. Optimum wellness can only be achieved if the patient cooperates and does a wide range of independence that will lead to a healing process. Most care facilities are applying this principle not because it will make job easier but it is also part of the treatment process. If there are difficulties along the way physically or intellectually, the healthcare team should find ways to these difficulties. The team should assess whether the patient can do task alone without struggle or it is advisable to seek full support in everyday living. Caregiver role plays an important role in the managing of care and should know how to assess in providing social independence and simple tasks to do.

Dignity

Every patient who is suffering dementia should be able to receive care with dignity. Anyone can attest that by putting yourself in the shoes of the patient. You should be able to assess if that is the treatment that is right to you. In that sense you, you can feel if you are receiving the treatment that you deserve. In applying to a person-centred approach of care, we must ensure that they are engaging in activities that they really like so that they will value their life even better.

Respect

This principle of care encompasses all other principles in such a way that every aspect or care should be based mainly on respect to the service user. Everyone has a unique character that should be respected. In dealing with elderly, make sure that their privacy is still being considered. In that way, they can still feel that despite their condition, that basic right of them are not being taken away from them. It is believe that when you want to be respected, you should know how to give respect as well. In applying it to person-centred, we must ensure that each individual has their own unique characteristic that we need to take note of, so that when we are providing care to them, they are able to appreciate our help. We must take note that it is the client’s welfare that we are serving and we should consider their uniqueness in order to provide a harmonious caring relationship.

Autonomy

This aspect of care should be given emphasis in its individual approach as every client has different ways in adapting to their current condition and to their new environment especially when they are being taken cared of outside their own home. Elderly especially those who are having early stage of dementia are in denial stage to the point that they are very eager in taking back their autonomy in managing their own health as well as their own way of living. This aspect of care must be taken seriously in a way that they don’t feel that their basic rights are not being taken away from them. It should be remembered by everyone involved in the care that patients should still be directly involve in the course of their treatment or rehabilitation. Creating a controlling environment against the patient will only delay the treatment course. In such cases that patients no longer capable of taking care of their own health, the nominated representative must be available that should not compromise the loved one quality of care.

Question 2

Institution perspective

This type of non-person-centred approach of care does not focus on the individual aspect of care but rather on its physical, social, and spiritual of the individual. The concept of care is focused on the general aspect of group of clients in the institution. It may be compared to an aspect of care wherein the care is based on the needs of the patients in general. The institution delivers the service to the client in a broader aspect. Examples of this are the set of diet to be served to a certain conditions are the same set of food. While some patient doesn’t want to eat a certain set that is generally being served to them, the institution do not adjust in the individual request of the patient except on the list of menus they can choose from. Though this should be applied mostly in every institution, in caring with dementia, this concept of care is not popular as the focused to their care should be more person-centred due to the needs of more personal and intimate care to be able to give an effective mode of treatment of care. So for the example regarding diet for a certain group of dementia patients in a facility, most likely that they will be demanding a different set from the one that is commonly being serve to them, it is equally important to note to the facility management to give in to some little request of the patients like extra egg or cup of tea instead of milk. Caring dementia clients needs to be more personal because of the uniqueness of the manifestations to every individual.

Bio-Medical Perspective

This perspective of care focuses on the medical aspect of treating the condition of dementia patients. It is equally important in the aspect of care because the medical team specifically in the field of research are in continuous pursuit of looking for treatment of the conditions associated with dementia patients. It is therefore important to the team to focus on the diagnosis and the course of care and treatment and constant documentation of the patients’ condition regardless of its connection of care to other care approach as the care of this is more on the scientific aspect of care and does not rely on the interdependence with other members of the care team.

Question 3

Reality-orientation Approach

This type of technique has been long use by different health care personnel not only in the care of people with dementia but as well as to other condition that affects the cognitive and reality function of the person. It involves with visual aides and basic knowledge orientation like asking about current events and today’s date. This approach is an interaction between the staff and the client. We know that patients with dementia are having trouble remembering recent events, that is why doing this approach is much needed and must be done more often. The staff can also ask the client some basic current events that the client should be able to remember if the memory is still fresh like the current Prime Minister of New Zealand. Asking the current date is equally important to prevent the client from memory deterioration. Most facilities should be able to post visible visual aids that are easy for the elderly to read like a big calendar to common areas where they can see it more often. The team can also innovate in doing it so in a way that it appears to be more fun and enjoyable to the clients. It can be done in a form of games where group of patients are gathered together and a facilitator ask them series of questions that involves reality orientation. In this way, they will feel it as a form of game without creating pressure to anyone being asked. It can be done in schedule as a way of socialising with others as well. Personal interaction can be done as much as possible. That is why all the health care workers should be able to learn these skills and be able to integrate it to their everyday interactions with the patients.

Validation Approach

Emotional aspect of the patients should always be considered in caring them. By doing a validation approach, they will allow the clients to voice out their concerns in contrast to what is actually you are observing. Care providers can do it by observing the patients emotional state and by asking them what they are currently feeling. By doing this, the patient will feel that their current emotional state are being considered and will uphold their integrity and purpose to live. Though this technique often seems to be complicated to care givers, but this approach seems to be the most important to the clients by just merely listening to them you will be able to ease what they are feeling.

Assistive Technologies

Nowadays healthcare institutions are dependent on the use of assistive technologies in carrying out their daily tasks in taking care of the patients. These technologies are very much helpful in managing the care of the patients like use of wheelchair, hoist, walker and others. Wheelchair is one of the most common equipment being used by elderly who are having difficulty in walking. It is important to note that as the age progresses they are becoming dependent to these equipment. Improper use of it will also lead to an accident that will add to the health problems of the elderly. Proper training to all including the staff is essential and as well as those caregiver who are under the direct care of the client. The patients should also be evaluated as often as possible if ever there is a need of other equipments to aid the care or there is a progress in order to provide more independence as much as possible.

Reminiscence Techniques

This technique is very common to those who are suffering Alzheimer’s disease. This is very effective if the one who are giving the care is a relative or someone who have been around with the client for a long time because the goal of reminiscing old good events are those that being shared by the client and the carer. In this way, the patient may relive an old fond memory that may enhance the ability to regain lost memory. By doing so, the client’s self-esteem is being established again that will give them a sense of life integrity.

Holistic Approach

This approach is very effective and should always be integrated in every care because it will encompasses all aspect of care by looking at the patient’s condition not only by their physiological needs but also their emotional, social, spiritual and psychological needs. By meeting each aspect of the individual’s needs, the client’s wellbeing is being uplifted and the caring process is broader that they can feel that their needs are being attended.

Question 4

Public Health and Health Promotion

In public health, there has been an effort to create a harmonious environment when it comes to equality, and cultural diversity as far as provision of the person-centred approach to individual is concerned. It is the goal of the private sector in partnership with the government to create a program that will be beneficial to elderly with dementia and across diversified cultural differences. They have even made it as a priority for dementia in all of its community involvement and awareness of the condition. In the health promotion aspect, the government had listed down six activities for those who have dementia. It includes minimising discrimination, where it should not be in any care, by promoting it, people suffering from this condition will be able to integrate in the community and have a graceful aging. Secondly, they focused on enhancing person-centred approach that every client with dementia should be able to receive this type of approach, as this would be more effective to elder clients. Thirdly, they promote activities that reduces stoke so the facilities must involve all the clients in a more active lifestyle and activities despite the challenges that the patients are having. Fourth is the reduction of incidence of fall as this is very common to elderly. Safety measures have been promoted and being practice to lessen the incidence among the clients. Their mental health is also important that is why is should be given a priority by assessing their mental wellbeing, and lastly, they encourage health and activity in older life in order to prevent these common conditions affecting elderly people. By engaging them to more active task while aging, they lessen the tendency of developing common geriatric conditions (National Service Framework, Department of Health, 2001).

Question 5

The goal of these health sector standards and codes of practice, and other standards in applying to a person-centred approach for individuals with dementia and other common geriatric health conditions is to be a guideline in practicing the care to this group of client. Since most of them they are unable to promote their rights as a consumer, these codes will be a guidelines for us and will be a moral etiquette checker if the provider are doing what is supposed to be done.

Conclusion

Since people with dementia may tend to be uneasy and disorganise due to the complexity of their condition, person-centred approach in managing their care should be inculcated in the health care team. Though it may be independent from institution perspective of care as well as to bio-medical perspective, the core of the care should be running in a person-centred approach since all we care after all is what the clients will feel when we are at their side and we are talking to them. While their abilities to communicate and recognise simple task is fluctuating, we should always be ready to guide them and relive what is missing in them so that they can continue living a life worth living.

Recommendation

Due to the fluctuating health condition of people with dementia and other common geriatric health conditions, the following recommendation are made concerning continuous staff training, public engagement and stakeholders support.

Continuous staff training

Staff and caregivers alike should be able to receive the latest information in giving care that would be focused on the person-centred approach, because it is commonly being neglected due to the outlying medical concerns of the client, this important aspect of care is often being taken for granted. The facilities should conduct at least once a year or as soon as there are latest innovation towards caring has been released.

Public Engagement

Though this is more common in an aging population like New Zealand, it is often neglected by the citizens due to various commitments they are dealing from a day to day. Engaging the family more often will be beneficial not only to the care facilities but also to the client who lacks attention from their own family.

Stakeholders support

It will not be successful without the support of everyone who are involve in the care. There should be a harmony in carrying out the goal of having a more patient focused care. Nonetheless, it is everyone’s responsibility as a providers to be the best that they can be for the benefit of the clients with dementia to achieve optimum health.

Bibliography

Electronic source

http://www.health.govt.nz

(National Service Framework, Department of Health, 2001).