Dementia Care Principles Archives - DementiaHub.SG

Recognising and Responding to Abuse in Dementia Care

Admin — Tue, 18 Feb 2025 15:59:59 +0000

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Elder abuse is a growing concern in Singapore, with cases continuing to rise in recent years. In 2022, 370 elder abuse cases were reported, up from 338 in 2021 and 283 in 2020.¹ One key factor is the overwhelming stress caregivers face, especially those caring for elderly persons with complex needs who depend on them for care.

As caregiving demands increase, caregivers may become physically and emotionally exhausted, which can sometimes lead to unintentional harm. Understanding the signs of abuse and knowing how to respond are crucial to protecting vulnerable groups such as persons living with dementia.

Read on to learn more about the types of abuse, how to recognise the signs, and what to do if you suspect abuse.

Types of Abuse

Abuse in dementia care refers to harm or mistreatment of persons living with dementia, and can take various forms: 

1. Physical Abuse

This can include hitting, pushing, or restraining the person living with dementia. 

2. Emotional Abuse

This can include verbal aggression, threats, intimidation, or isolating the person living with dementia from others, which can harm their emotional well–being.

3. Neglect and Self-Neglect

This can include failing to provide basic needs such as food, clothing, or medical care. 

4. Financial Abuse

This can include stealing money or assets, coercing the person with dementia to sign over their assets or power of attorney.

5. Sexual Abuse

This can include unwanted touching or sexual acts. 

Recognising Abuse in Dementia Care

Why Is It Crucial to Recognise Abuse?

Recognising and responding to abuse in dementia care is essential, as persons living with dementia are often unable to report abuse themselves. This is due to several factors:

Inability to Recognise Abuse

Cognitive decline can make it difficult for persons living with dementia to recognise mistreatment. They may not have the awareness to identify abusive behaviour or might mistake it for part of their normal care routine.

Difficulty Expressing Concerns

Even if they are aware that something is wrong, persons living with dementia may struggle to communicate their feelings. Loss of language skills and cognitive challenges can prevent them from expressing their distress or seeking help.

Signs and Symptoms of Abuse

The following are common signs and symptoms that may indicate abuse:

Physical Abuse Warning Signs 

Emotional Abuse Warning Signs 

Neglect Warning Signs 

Financial Abuse Warning Signs 

Sexual Abuse Warning Signs 

Physical Abuse Warning Signs 

Emotional Abuse Warning Signs 

Neglect Warning Signs 

Financial Abuse Warning Signs 

Sexual Abuse Warning Signs 

Note: This section was adapted from HelpGuide: Elder Abuse and Neglect.

Risk Factors for Abuse in Dementia Care

Abuse can occur in any caregiving situation, but certain factors can increase the risk. Common risk factors include:

Caregiver Stress

Dementia caregiving is demanding, and the stress can lead to frustration and, sometimes, abusive behaviours.

Isolation

Caregivers and their loved ones may be isolated, with little support or outside help.

Caregiver Mental Health Issues

Pre-existing mental health conditions, such as depression or other diagnoses, can impact a caregiver’s ability to cope with stress, potentially contributing to abusive behaviours.

Behavioural Changes in Dementia

As dementia progresses, a person living with dementia may experience changes in behaviour, such as increased agitation or disinhibition. These changes can be challenging for caregivers, who may feel stressed or overwhelmed.

History of Domestic Violence

A history of domestic violence in the home increases the likelihood of abuse.

Responding to Abuse

If you suspect abuse, immediate action is essential to protect the person living with dementia. Here are a few steps you can take:

Ensure Immediate Safety

If the person living with dementia is in immediate danger, take steps to remove them from the situation and ensure their safety. If there is no immediate risk, monitor the situation closely and consult with relevant professionals, such as social workers or healthcare providers, to determine the best course of action.

Document and Gather Evidence

Document any signs of abuse, including physical injuries, changes in behaviour, or verbal reports. Keep detailed records of any incidents, as this will be important for reporting.

Report the Abuse

Report suspected abuse to the relevant authorities. In Singapore, contact the National Anti-Violence and Sexual Harassment (NAVH) Helpline at 1800-777-0000. This 24-hour helpline provides support and triages cases to the appropriate services. For non-life-threatening emergencies, you can also report abuse online via the NAVH Reporting Form on FormSG. You can also approach the Office of the Public Guardian (OPG), which provides support for safeguarding vulnerable adults at risk of abuse or exploitation.

If the situation presents an immediate danger to life or safety, contact the police immediately by dialling 999.

Follow-up and Support

Ensure the person living with dementia continues to receive appropriate care and support. Work with social workers, healthcare providers, or other professionals to address the situation and ensure their ongoing safety.

For more information on protecting vulnerable individuals under the law, you can refer to the Vulnerable Adult Act.

Conclusion

Abuse in dementia care affects more than just older adults. It can impact anyone experiencing cognitive decline, regardless of age. Persons living with dementia are particularly vulnerable, and any form of abuse can have devastating consequences on their physical and emotional well–being.

It is essential for professionals, caregivers, and the community to remain alert. By recognising the signs of abuse early, taking prompt action, and providing necessary support, we can help prevent abuse. In doing so, we can ensure that those living with dementia are treated with the respect, care, and protection they deserve.

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Understanding the Four Pillars of Humanitude

Admin — Sat, 07 Sep 2024 03:02:42 +0000

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As dementia progresses, the needs of those living with the condition evolve, requiring caregivers to adapt and find new ways to connect and support their loved ones. This journey can be challenging but also rewarding, as it offers an opportunity to enhance the quality of life through caregiving. The Humanitude methodology provides a structured approach, based on four key pillars—Gaze, Speech, Touch, and Verticality—to address these changing needs effectively.

This article will explore the four pillars of Humanitude and provide practical tips on incorporating these pillars into your caregiving practices.

What is Humanitude™?

Humanitude is a care methodology developed by Yves Gineste and Rosette Marescotti, specifically designed to improve the quality of life for persons living with dementia. It combines a philosophy of care with practical techniques that emphasize respect, empathy, and connection. The four pillars of Humanitude—Gaze, Speech, Touch, and Verticality—are central to this approach. Each pillar represents a fundamental aspect of human interaction, helping caregivers foster positive relationships and support the emotional and physical needs of those in their care.

Benefits of Humanitude

Scientific research and outcomes have highlighted several key benefits of Humanitude care for persons living with dementia, delirium, and cognitive impairments:

Improved ability to perform activities of daily living (ADL).
Greater participation in daily activities.
Enhanced physical movement and independence.
Overall improvement in well-being.
Decreased ill-being.

For caregivers working in healthcare, practicing Humanitude has been associated with:

Reduced burnout
Increased empathy
Improved attitudes

Applying the Four Pillars of Humanitude: Do's and Don'ts

1. Humanitude Gaze

Gaze is a fundamental non-verbal pillar of Humanitude, essential for building emotional connections. It stimulates oxytocin, the hormone associated with love and bonding. The Humanitude Gaze is characterised by being axial, long, near, and horizontal. However, it is important to personalise this technique to suit the individual needs and preferences of each person.

Do's

Horizontal: Establish eye contact at the same eye level as the person

Front: Approach the person from where they are looking

Long: Maintain eye contact for a longer duration

Near: Stay close, ideally within 25 cm

Don'ts

Vertical: Avoid looking down from above.

Sideways: Refrain from glancing sideways, as it can be perceived as disinterest.

Brief: Don’t make eye contact fleeting.

Distant: Avoid looking from more than an arm’s length away.

2. Humanitude Speech

Speech is a vital pillar of Humanitude, marked by a low, soothing tone, calm melodic intonation, and positive reinforcement. These elements work together to create a reassuring and validating environment, making interactions more comforting and supportive.

Do's

Low Tone: Use a low tone of voice
Melodic Intonation: Speak with a gentle, rhythmic tone
Calm and Soothing Delivery: Keep your speech slow and composed.
Positive Reinforcement: Use encouraging language

Don'ts

Harsh or Loud Tone: Avoid raising your voice or using a harsh tone
Dismissive Phrases: Refrain from using short, dismissive phrases like “what!”
Negative Words: Avoid negative language, such as criticising someone for being “slow”.

3. Humanitude Touch

Touch is a non-verbal method to communicate care and comfort, described in Humanitude with characteristics such as wide, soft, slow, frequent, caressing, and embracing.

Do's

Wide: Use a relaxed, open palm to make contact, slightly wide apart, creating a feeling of warmth and embrace.
Soft: Touch should feel like caressing a baby—gentle and reassuring.
Slow: Move your hand slowly to convey patience and care, akin to pacifying a baby.
Start on Accepted Areas: Begin with socially accepted areas like the hands, shoulders, or forearms.

Don'ts

Claw: Avoid gripping with fingers
Fast: Don’t rush your touch; quick movements can be startling.
Small Surface: Avoid using only fingertips or pointy surfaces, which can feel sharp or uncomfortable.
Scarce: Don’t shy away from or avoid touch; consistent, gentle contact is important.

4. Verticality

Verticality is a key pillar of Humanitude, vital for maintaining a person’s self-esteem and physical health. Since we naturally walk on two feet, staying upright helps foster a sense of confidence, health, and freedom. It reduces bedridden rates and promotes overall wellbeing.

Do's

Upright Care: Whenever possible, provide care while the person is standing or sitting up, rather than lying down.
Encourage Movement: Aim for the person to stand or walk for at least 20 minutes a day, even if in short sessions.

Don'ts

Avoid Unnecessary Lying Down: Refrain from providing care while the person is lying down if they can sit up or stand with assistance.

To see these principles in action, watch the video below.

The Four Pillars of Humanitude: Gaze, Speech, Touch and Verticality
Source: Humanitude Singapore

Watch Rosette Marescotti guide a caregiver in using Humanitude techniques to encourage a woman living with dementia to go for a walk. This video showcases the transformative impact of the four pillars.

Conclusion

Humanitude provides a structured approach to dementia care in Singapore, ensuring that caregivers are equipped with the tools and knowledge to create these meaningful connections. The four pillars of Humanitude can significantly enhance caregiving experiences for both yourself and the person in your care. These techniques are not just about providing care; they are about creating moments of connection, understanding, and compassion.

In your journey as a caregiver, remember that every interaction is an opportunity to affirm the dignity and humanity of your loved one living with dementia. With the right approach, you can turn challenges into opportunities for connection and growth, ensuring that your loved one feels valued and supported at every stage of their journey.

To learn more about Humanitude™, visit the Humanitude™ Singapore website to explore a variety of resources, including videos and insights into Humanitude care. If you are a healthcare professional, you may consider signing up for the Humanitude™ Care Action-Training course to discover a relationship-centred approach to caring for persons living with dementia. For caregivers, you may consider signing up for the Humanitude™ Caregivers Training courses.

AUTHOR BIO

HUMANITUDE SINGAPORE

Humanitude Singapore is part of Humanitude International Network of providers for training programmes on Humanitude Care Methodology. Since 2019, Humanitude Singapore has been providing Humanitude training for a thousand of healthcare professionals in Singapore, from various care settings, including acute hospitals, community hospitals, nursing homes and day care centres. Through various collaborations in the healthcare communities, Humanitude Singapore has become a trusted partner with a shared vision of enhancing the well-being of caregivers and vulnerable care recipients, including persons living with dementia.

Website

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Dementia Care Training for Care Professionals

Admin — Tue, 07 Mar 2023 08:13:32 +0000

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To build competency and capability of Care Professionals, the Agency for Integrated Care (AIC) developed the Dementia Care Competency Framework to align the training pathways. This alignment was made to improve the quality of care provided to persons living with dementia and support for their caregivers.

This article expands upon this framework to list the available training programmes for Care Professionals wishing to upgrade their knowledge and skills in the various fields of dementia care.

Dementia Care Competency Framework Version 1.1
Source: Agency for Integrated Care

This guide was developed for health and social care workers in the intermediate and long term care and community sector. It provides in-depth information on the structure and competency domains of the framework.

Foundational Level

For individuals with no prior training in dementia, who may have minimal or brief contact with persons living with the condition. These e-learning or training courses are centred on building dementia awareness as well as basic techniques to communicate and assist persons living with dementia in the community.

1. Agency for Integrated Care

Dementia Awareness: Foundation Level

Key modules include:

What is Dementia, its types, and risk factors
ABCD Signs and Symptoms of Dementia
Interacting & communicating with people living with dementia
Ways to reduce the risk of getting dementia
Dementia-Friendly Communities

Participants will receive a certificate upon completion of the evaluation form and module.

Basic Level

For Care Professionals in health and social services who have direct contact assisting persons living with dementia in their course of work. These training courses aim to provide learners with the knowledge of the impact of dementia and the use of person-centred care approaches when caring for persons living with the condition.

1. Agency for Integrated Care

Dementia Care Basic Level –
Person-Centred Care and Behaviours of Concern

Through this e-learning course, participants will learn how to:

Describe the concept of Person-Centred Care
Recognise the philosophy of care of persons living with dementia
Define the VIPS
Classify the unmet needs
Manage the behaviours of concern

Participants will receive a certificate upon completion of the evaluation form and module.

Dementia Care Basic Level –
The Brain and Understanding of Dementia

Through this e-learning course, participants will learn how to:

Recognise the importance of activities/ engagement for a person living with dementia
Describe what a meaningful activity is
Assess the individual’s needs and abilities
Plan activities for persons living with dementia

Participants will receive a certificate upon completion of the evaluation form and module.

Dementia Care Basic Level –
Enriching Lives

Through this e-learning course, participants will learn how to:

Recognise the importance of activities/ engagement for a person living with dementia
Describe what a meaningful activity is
Assess the individual’s needs and abilities
Plan activities for persons living with dementia

Participants will receive a certificate upon completion of the evaluation form and module.

Interested participants who wish to register for courses available on the AIC LMS are required to sign up and create an account before proceeding with registration.

2. Dementia Singapore

A. Understanding Dementia – Nature & Impact*

This training course aims to introduce learners to dementia and its impact on those affected by the condition. Learners are also introduced to the principles of Person-Centred Care and how best to support persons living with dementia in everyday activities through a person-centred lens.

Course objectives:

Describe the signs and symptoms of dementia, delirium and depression
Identify the common causes and risk factors of dementia
Describe the impact of dementia on the person with dementia and family caregivers
Recognise the principles of Person-Centred Care
Identify ways in which we can assist the person with dementia in everyday activities to enhance their well-being.

B. Introduction to Person-Centred Care*

This training course aims to provide learners with strategies to promote person-centred care and apply self-care strategies for both professional care staff and family caregivers.

Course objectives:

Explain the impact of the environment on persons with dementia
Identify strategies for promoting person-centred care
Describe the impact of dementia on professional staff
Recognise signs and symptoms of stress, compassion fatigue, and burnout
Apply self-care strategies for self and caregivers

C. Behavioural Communication in Dementia*

This training course aims to equip learners with strategies for effective communication with persons living with dementia and facilitate understanding of behaviour change as a means of communicating unmet needs, to apply a range of options to manage the impact of behaviour change.

Course objectives:

Describe the impact of dementia on communication
Identify strategies for effective communication with a person with dementia
Understand behaviour associated with dementia
Identify potential triggers for behaviour associated with dementia
Identify a range of options for managing the impact of behaviour
change
Identify signs that would alert you to the possibility of elder abuse

D. Purposeful & Meaningful Engagement in Dementia Care*

This training course aims to equip learners with the knowledge and skills to promote meaningful activity and engagement to meet individual needs of persons living with dementia.

Course objectives:

Recognise the value of promoting meaningful activity for and engagement with persons living with dementia
Identify goals of engagement to promote different aspects of wellbeing
Identify ways of adapting activities to meet individual needs
Develop an individualised activity plan for a person with dementia

E. Palliative Approach to Dementia Care*

This training course aims to provide learners with an understanding of how persons living with dementia can be supported with a palliative care approach relating to their physical, psychosocial, and spiritual needs.

Course objectives:

Appreciate the importance of Palliative Care approach in dementia care
Identify symptoms associated with End of Life (EOL)
Identify ways to manage symptoms associated with EOL
Recognise cultural and religious differences associated with death and dying
Identify how you can integrate the learning from the course into your care practices

F. Enabling EDIE (Educational Dementia Immersive Experience)

This is an immersive workshop that enables participants to see the world through the eyes of a person living with dementia. Utilising high-quality virtual reality technology, this workshop enhances their knowledge of the impact of dementia and adopt reablement approaches that will improve the quality of life for persons living with dementia.

Course objectives:

Describe the perspective of a person with dementia
Identify support needs in partnership with the person with dementia and their caregiver
Develop a dementia support plan that focuses on enabling a person with dementia Explain the impact of the environment on persons with dementia

*Participants who complete courses (A) – (E) will attain a Certificate of Accomplishment in “Foundations of Person-Centred Dementia Care”.

3. Kwong Wai Shiu Hospital

ITE Skills Certification in Healthcare – Dementia Care (Basic)

This course aims to equip participants with knowledge of basic healthcare and home care such as providing oral feeding, personal grooming and hygiene services as well as basic dementia care.

On course completion, participants will be able to work as Health Care Assistants (HCA) in the Community Care sector, especially in nursing homes or community hospitals that require basic knowledge and skillsets for dementia care.

4. St. Luke’s ElderCare

Care of Client with Dementia (Basic)

This 2-full day course is designed, in line with DCCF Framework to provide learners with the basic knowledge and skills to improve well-being of persons living with dementia and their caregivers.

Course objectives:

Describe what is dementia, signs and symptoms
Understand how condition impacts persons living with dementia and their caregivers
Apply Person Centred Care (PCC) approach
Facilitate holistic activities to promote independence and abilities
Understand common behaviours of concerns and learn strategies to address them
Demonstrate effective communication techniques
Recognise when a person with dementia experiences harm, abuse and neglect
Identify self-care strategies to manage stress for self and caregivers in the caring journey of persons with dementia

Intermediate Level

For Direct Care Staff in the health and social services who have contact and provide direct support to persons living with dementia and their caregivers, may have a guiding or supervisory roles, or are able to influence workplace processes. These training courses will enable care staff to adopt person-centred approaches into their care practice; develop, implement and review care plans; and create dementia-friendly environments and activities.

1. Dementia Singapore

A. Integrated Care for Dementia (Intermediate)

Grounded on evidence-based practice, this blended learning course equips learners with theoretical frameworks, evaluation tools, and intervention strategies to address and support the multiple needs of persons living with dementia and their caregivers across medical, psychological and social domains. This course provides learners with the necessary knowledge and skills to embark on their journey as an entry level dementia practitioner in the community care sector.

Course objectives:

Apply Person-Centred Care approaches to care planning for persons living with dementia
Understand health and neurological impairment
Assess the needs of caregivers to provide information and referral to access relevant health and social services
Recognise ethical principles, regulatory and legislations relevant to dementia
Provide activities to maximise autonomy and promote wellbeing
Develop and implement techniques which minimise the impact of changed behaviour

B. Implement Namaste Care (Intermediate)

Namaste Care is a structured intervention for persons living with advanced dementia, which incorporates sensory intervention, social contact and environmental modification. It aims to honour each person for their unique personhood, nurturing the individual spirit with meaningful activities and a loving touch approach, within a calm and home-like environment.

This blended course aims to provide learners with theoretical and practical knowledge of delivering Namaste Care as a specialised intervention for persons living with dementia in their settings.

C. Reminiscence Arts for Dementia

Reminiscence Arts for Dementia is a facilitated learning journey which prepares learners to conduct small-group interactive reminiscence arts sessions for persons living with dementia using objects, storytelling, and artwork materials.

It aims to guide learners with theoretical and practical knowledge of preparing individual profiles and build these characteristics into their design, preparation, and implementation of reminiscence group activities. Live demonstration and skills practice are expected in this programme, where the key principles of person-centred approaches are spotlighted, deepened, and integrated in the group learning.

D. Dementia Care Mapping (DCM) for Realising Person-Centred Care

This course aims to provide participants with the knowledge of person-centred dementia care and its application in practice in the care setting in which they work, as well as the ability to use DCM™ to assess and make recommendations for the realisation of person-centred dementia care in the care setting in which they work.

Course objectives:

Describe the psychological needs of people with dementia, and ways to meet them.
Use the four phases of a DCM™ practice development cycle: briefing, observation, feedback, and action planning to realise person-centred care.
Brief colleagues on the purpose and conduct of DCM™ practice development cycles in your place of work.
Use DCM™ to appraise and make recommendations for realizing person-centred care.
Engage in collaborative action planning with care staff.

2. St. Luke's ElderCare

Care of Client with Dementia (Intermediate)

This 4-full day course is designed, in line with DCCF Framework to upskill learners to provide supervisory and guiding role to staff under their care in using person centred approaches, and influence change in workplace practices and processes to enrich quality of life of persons living with dementia and their caregivers

Course objectives:

Describe different types of dementia, causes and its implications to practice
Distinguish between dementia, delirium and depression
Discuss multi-dimensional changing needs and management of persons with dementia at different stages
Create Dementia Friendly Environments (Social and Physical)
Apply non-pharmacological approaches in managing behaviours of concern associated with dementia
Plan, design and facilitate person-centred activities to maximise successful engagement
Describe use of palliative care in persons with dementia
Recognise importance of caring for self and developing positive coping techniques
List community services available to provide support and respite to caregivers
Identify process involved to support persons with dementia who may be experiencing neglect, harm or abuse

3. St. Luke's Hospital

Becoming Dementia Care Ready! (Intermediate)

This course covers the seven core competency domains required of an individual in supporting persons with dementia. The course focuses on in-depth knowledge and skills required in providing direct care and support to persons with dementia and their caregivers.

Course objectives:

Assess persons with Dementia
Apply Person-Centred Care at Work
Support the well-being of Persons with Dementia
Minimise the impact of Behaviours of Concern
Maintain the Dignity, skill and Health of persons with Dementia
Assist persons with Dementia in Palliative Care
Assist caregivers to support Persons with Dementia

4. The Palliative Care Centre for Excellence in Research and Education (PalC)

Geriatric Palliative Care in Advanced Dementia

This course aims to develop learners’ theoretical and practical knowledge in delivering competent, evidence-informed palliative care in advanced dementia.

Course objectives:

Identify patients’ needs
Manage symptom Issues
Provide for continuity of care
Prognosticate reasonably
Carry out end-of-life discussions with patients and caregivers
Provide support to caregivers

Advanced Level

Relevant for Specialists in the health and social services setting who have the expertise in caring, treating and supporting persons living with dementia and their caregivers, and play a supervisory and guiding role at the workplace or clinical setting.

1. Dementia Singapore

Dementia Care Mapping (DCM) for Supported Living

Adapting DCM to support home-based care settings. The application of DCM for Supported Living will allow you to assess and make recommendations to the care of the person with dementia living at home. It also provides evidence-based feedback to care staff working in the home setting.

Course objectives:

Understand the purpose and conduct of using DCM™ in homebased care settings.
Carry out DCM™ coding and data processing for DCM™ in homebased care settings.
Provide evidence-based feedback to staff working in home-based
care.
Identify a developmental plan for staff working in home-based care

This course is available upon request.

2. Social Service Institute

Leadership and Management for Dementia Care Services

This programme is designed with the overall aim of preparing staff to lead and manage dementia care services successfully. Participants will review their personal skills and traits as leaders. They will be introduced to different leadership theories, focusing in more depth on outcome-based leadership and organizational learning. The programme also covers managing the quality of Dementia Care services, motivation of employees and conflict Management.

Course objectives:

Demonstrate the importance of interpersonal skills and teamwork in Dementia Care Services.
Apply leadership theories and frameworks
Use outcome-based leadership tools to evaluate potential improvements to Dementia Care Services.
Use organisational learning tools to analyse departmental and organizational problems.
Use quality improvement tools to use to monitor and evaluate improvements in departmental or organizational processes.
Apply conflict resolution strategies in Dementia Care Services

To view more courses on dementia care, visit the AIC LMS Marketplace.

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Palliative Care

Admin — Sat, 08 Oct 2022 09:25:39 +0000

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End-of-life care, or palliative care, aims to support a person in the later stages of a life-limiting condition to live as well as possible until they pass on. It also aims to support family and caregivers during this time and after the person passes on. End-of-life care may last for weeks, months, or occasionally years. It is often difficult to know exactly when a person living with dementia is approaching the end of their life.

A person-centred care approach is an important aspect of palliative care as it is with dementia care in general. A person-centred approach, according to Professor Tom Kitwood, a major contributor in the field of dementia care: values a person who lives with dementia; treats the person as an individual; looks at the world through the person’s perspective; and addresses the effects of the social environment on the person living with dementia.¹ These things are just as important for a person living with dementia as they live their final days.

Nearing the End of Life

There are symptoms in the later stages of dementia that can suggest the person is reaching the final stage of their illness, but this may be difficult to predict.

These include:

Speech limited to single words or phrases that may not make sense
Needing help with most everyday activities
Eating less and having difficulties swallowing
Bowel and bladder incontinence
Being unable to walk or stand, problems sitting up and controlling the head, and becoming bed-bound.

A Good Death

For many people, a ‘good death’ means:

Being treated with compassion and respect
Being kept clean, comfortable and free from distressing symptoms
Being in a familiar place surrounded by those close to them End of Life Care seeks to support all aspects of your loved one’s wellbeing, especially:
- Physical needs (including pain relief and management of other symptoms)
- Emotional health
- Social health – their relationships with others
- Spiritual beliefs

Professional Care

End-of-life care for a person living with dementia can involve a number of different professionals working together, including the doctor, nurses, social workers or care home staff. Palliative care professionals at a local hospice or hospital may give specialist input if this is needed. This team of professionals should keep you updated as the person’s condition changes and involve you in any decisions. The person should always have an up-to-date care plan that includes end of life plans and is shared with those involved in the person’s care. It is likely that a person living with dementia is nearing the end of their life if they have these symptoms, along with other problems such as frailty, infections that keep coming back, and pressure ulcers.

Additional Resources

My Legacy

This is a Singapore government website which contains information on end-of-life planning.

Challenge by Public Service Division: Is There Room For Dying Well In Singapore?

This 2014 article on a Singapore government Public Service Division blog discusses the quality of death in Singapore.

Singapore Hospice Council: Palliative Care

The Singapore Hospice Council’s website provides information on what palliative care is, and various aspects of palliative care such as why it is needed, how it can help, where it is provided, and how it can start.

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Brooker, D. (2004). What is person-centred care in dementia?. Reviews in clinical gerontology, 13(3), 215-222.

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Person-Centred Care in Dementia

Admin — Mon, 17 Oct 2022 18:19:25 +0000

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The term “person-centred care”, as a frequently-used term and a developing area,¹ does not have a single agreed definition. When loosely defined, it has been used to refer to philosophies of caring that include goals that range from an emphasis on the dignity of the person being cared for, treating this person as an individual, ensuring that care is organised around the person, to involving the person and their close kin in their own care planning.²

Many of the person-centred care approaches within the dementia care field today draw from the work of Tom Kitwood’s seminal work on dementia care. Kitwood highlights that personhood and the relationships between the persons in question and others around them are the core of person-centred dementia care. Instead of historically dominant thought paradigms which claim that only neurological processes cause dementia, Kitwood emphasises that the social environment of the persons being cared for is a critical determining factor for the wellbeing of these persons, and the presentation of their neuropsychological conditions, according to the Enriched Model of Dementia, which will be detailed later in this article. The social environment concerns the way in which the cared-for persons are perceived by the persons around them, and consequently, the kinds of relationships that these persons have with them.

Because of the central role has played in the development of theory, practice, and history of person-centred dementia care, this article will begin by exploring the influences upon his work. Following this, the article will briefly describe a few prominent approaches to person-centred care as practiced in the dementia care field today, namely the Spark of Life approach, the Eden Alternative, and Dawn Brooker’s VIPS approach.

Person-Centred Care from a Management Perspective

Source: Agency for Integrated Care

Stephen Chan (Care Services, Dementia Singapore) and Low Mui Ling (Peacehaven Nursing Home, Salvation Army) share about the importance of person-centred care and how it has benefitted care staff and clients/residents in dementia care settings.

“Person-centred care”, as it is used in the field of dementia care, was drawn by Kitwood from the work of the American psychotherapist Carl Rogers,³ who developed and named the therapeutical approach known as person-centred therapy. Key characteristics of this approach include the assertions that people relating to the persons in question must be genuine (the condition of congruence), empathic, i.e., understand the client’s experience and perspective, and finally, have unconditional positive regard, that is, to approach the person with no judgment.⁴ These characteristics are apparent in the person-centred care approach of dementia care.

Enriched Model of Dementia

The development of a biopsychosocial model of health, promoted by the American psychiatrist George Engel in the late 1970s,⁵ and incorporated into Kitwood’s Enriched Model of dementia, also contributes to the concept of person-centred care of dementia. In this model, dementia is a condition that should be understood from a view that takes into account the combined effects of biological, psychological, and sociological factors on the development of the condition of a person with dementia in an integrated way.⁶

Prominent Person-Centred Dementia Care Approaches

Spark of Life Approach

The Spark of Life Approach, pioneered by Jane Verity, who had studied with Tom Kitwood, and co-developed by Hilary Lee, began as an interactive therapeutic social group programme called the Spark of Life Club Program, which aimed to provide an environment for persons with advanced dementia to experience rehabilitation and recover lost abilities. The programme was researched by Hilary Lee for her Master’s Degree, and further developed into a more extensive philosophy and programme for dementia care.⁷

Key points of focus of the Spark of Life approach are the quality of life of persons with dementia, and the belief that the recovery of abilities in a supportive and understanding social and emotional environment, termed as ‘rementia’, can occur.⁸

The Eden Alternative

The Eden Alternative, an approach towards person-centred care, was developed by geriatrician and nursing home physician William H. Thomas in 1991⁹ response to what Thomas believed were the “three plagues of nursing homes: loneliness, helplessness, and boredom.”¹⁰ Its vision is described by principles known as the 10 Eden Alternative principles:

The 10 Eden Principles

1. The three plagues of loneliness, helplessness and boredom account for the bulk of suffering among our elders.
2. A fulfilling life involves creating a human habitat with people of all ages and abilities (including children), plants and animals.
3. The antidote to loneliness is companionship.
4. The antidote to helplessness is the opportunity to give care as well as receive care.
5. The antidote to boredom is variety and spontaneity.
6. All activity must be meaningful to the person.
7. Medical treatment is not the only way.
8. People need to be able to make decisions for themselves.
9. Culture change is a never ending journey.
10. Wise leadership from all of us is essential.¹¹

The Eden Alternative approach was developed for persons living in nursing homes, and specifically, for older persons. This approach is, in effect, also practiced in dementia care settings because of the large overlap between older persons living in nursing homes and persons with dementia.

Eden principles place a large emphasis on ensuring companionship and activity. In reflection of this emphasis, Eden facilities usually feature engagement with animals, children and youths, and the larger community, which the nursing home residents are encouraged to interact and build relationships with. According to research, interactions with children, youths, and animals may have significant impacts on home residents’ loneliness and feelings of helplessness,¹² while connecting them relationally to the community around them. These initiatives support the dignity and social connectedness of Eden facility residents.

The VIPS Perspective of Person-Centred Care

The psychologist Dawn Brooker’s approach to person-centred care in the dementia care context is defined as follows:

Person-centred care comprises four elements, which are

V for Valuing: Valuing people with dementia and those who care for them
I for Individuals: Treating people as individuals
P for Perspective: Looking at the world from the perspective of the person with dementia
S for Social Environment: A positive social environment in which the person living with dementia can experience relative wellbeing

This is otherwise expressed by the formula “PCC (person-centred care) = V + I + P + S”.¹³

Each element of VIPS is comprised of several smaller indicators. For example, Valuing people can be indicated by how well everyone in a care team or organisation knows what the team stands for (Vision), and the extent to which systems are in place to ensure staff know they are valued as a precious resource (Human resources).¹⁴ View a full list of the indicators that describe each element.

Care Cultures

Culture, according to different definitions, refers to information acquired from other individuals through social learning, such as by imitation or communication, that can affect an individual’s behaviours, according to the psychologist Steven Heine,¹⁵ or a historically transmitted pattern of meanings embodied in symbols by which people communicate knowledge and attitudes, according to the anthropologist Clifford Geertz.¹⁶ In these definitions of culture, information is learnt from others and historically perpetuated.

In the context of an organisation, organisational culture can be defined as “the assumptions shared by members of an organisation, used in their daily practice, and reinforced through providing successful solutions to problems faced in the course of work”.¹⁷ This means that the culture of an organisation that cares for persons with dementia is socially transmitted across generations of staff. Organisational culture has implications on the way persons with dementia are cared for in the long run, since the way the organisation cares for care recipients is heavily influenced by its culture, which does not easily change.

Person-centred care is one such culture. It both influences the thoughts and actions of care teams in a systemic way, and is perpetuated by what care teams think and do. For an organisation’s culture to sustainably change towards a person-centred culture of care, everything that can potentially influence the day-to-day culture of care should be addressed with an eye on the long term.¹⁸ This includes the environment of the organisation, the values of different levels of organisational staff, the communication patterns between staff teams and between staff and the persons with dementia, amongst other factors.

Integrating Person-Centred Care Approaches With Local Approaches

It is also worth considering how existing cultural perceptions and worldviews in the place where person-centred care is being applied may affect the way person-centred care is received, and is integrated into care approaches, by persons being cared for, caregivers, organisations, and organisational staff. Each region, community, or organisation has a culture that differs slightly from others. In addition, in the Singapore context, organisational staff are from different cultural groups and nationalities. Studies have shown that a specific culture’s culture, context, and language can influence the adaptation of person-centred care related tools, such as the Person-centred Practice Inventory – Staff (PCPI-S).^{19, 20} This suggests that inter-cultural communication of person-centred concepts to organisational leaders and staff members needs to be done with an awareness of cross-cultural differences in order to ensure that there is both an accurate understanding of person-centred care, and consensus over how the organisation intends to proceed having understood this perspective of care.

Bringing Brooker’s VIPS person-centred care approach to dementia care into local contexts does not necessarily mean replicating a new model of care without continuing the care approaches inherent within an organisation’s culture and values already being practiced in that local context. Instead, care teams and organisations could consider their own vision and approach to care alongside the person-centred care approach, and decide the best course of action within a coherent value system.

Measures of Person-Centred Dementia Care

Read Tools for Dementia Practice & Research for more information regarding measures of person-centred care, such as the Dementia Care Mapping 8^th Edition, the VIPS Assessment Tool, and other tools.

Strengths & Limitations of Person-Centred Dementia Care

A commitment to person-centred dementia care would require a consideration of its strengths, the evidence base for its efficacy in practice, and its challenges and limitations.

Empowerment of Persons With Dementia and Their Kin

A key strength of person-centred care is that it puts power in the hands of persons with dementia and their close kin. Apart from providing a moral imperative to care for persons with dementia by recognising the need to value their personhood, person-centred care approaches, by recognising the preferences, wishes, and unique identities of persons with dementia and their kin, also provides these persons with the power to shape their own care and their everyday lives.21 In addition, though persons with dementia may not have the ability or legal power to make decisions that require a higher level of mental capacity, a social- and health-care system characterised by person-centred care would involve close kin, such as caregivers, trusted family members, or legal attorneys, in important decisions regarding their personal matters. This allows care systems to, rather than treating care recipients as impersonal objects to operate on, instead work alongside these recipients as empowered partners involved their own care.22

A Focus on Systemic, Organisation-Wide Changes

In addition to highlighting the general need to provide care that places care recipients at the centre of care services, person-centred care approaches have also articulated the need for making systemic changes to care organisations by changing their care cultures. This focus on changing care cultures raises the probability that an organisation’s implementation of a person-centred care approaches will be sustained in the long-term.

Furthermore, by emphasising the need to empower organisations’ management and staff to work together to deliver care, person-centred approaches are in general comprehensive in describing how personnel practices are an important intervention point in the effort to align organisational culture with person-centred care. This is especially so because management teams set organisational values and vision, and staff require the support of management teams to execute their care.²³ This detailed discussion on how organisations should deliver care to care recipients is a strength of person-centred care approaches.

Literature and Evidence Base on Person-Centred Care Approaches

The literature on person-centred dementia care approaches is currently developing alongside the field of person-centred dementia care practice. Currently, studies on person-centred dementia care have shown support for the effectiveness of these approaches.

In a 2019 systematic review of organisational-level implementation of person-centred care found that the quality of life of care recipients can be increased, and neuropsychiatric symptoms reduced, when this approach is implemented at an organisation-wide level with full support from organisation leaders.²⁴ Another study involving a systematic review and meta-analysis of person-centred dementia care living in long-term care facilities and homecare settings found that the approach is able to reduce agitation, neuropsychiatric symptoms, and depression, while improving quality of life, though the learning and skill development of care personnel is needed for care recipients’ quality of life to be improved, and for effects on receipients’ behavioural problems to be sustainable.²⁵ Finally, a cross-sectional study conducted in 7 nursing homes in Singapore, published in 2021, concluded that the overall level of person-centred care was positively associated with better resident well-being.²⁶

There is a growing body of literature on ways to measure person-centred dementia care, which in turn is facilitating the quality and quality of literature and evidence on person-centred dementia care. For more information on measures of person-centred dementia care, find out at Tools for Dementia Practice & Research.

Cultural Differences

A challenge that teams that attempt to advocate person-centred dementia care faces is that it has to consider, as suggested in the earlier “care cultures” section of this article, the local cultures of the groups which the person-centred care approach will work with. Person-centred care approaches have an inherent value system and philosophy which may have differences with the values and thinking that the organisations, personnel, care recipients, caregivers, and local community-at-large may espouse. Communication and dialogue between the person-centred care advocates and the local community is encouraged to agree on and articulate the values and plans that the local organisation itself decides to proceed with.

Working With Different Organisations and Parties to Deliver Care

A challenge in implementing person-centred care is the necessity of working with different parties who may not work to deliver care in a person-centred way. For example, when a person with dementia and their care team face a care system or care personnel who may not be familiar with the care recipient due to rapidly changing staff or staff attrition, or because different service providers may not communicate or collaborate sufficiently, the care recipient will lose out on care quality. Wider cultural awareness on person-centred care, and discussions on best practice approaches for collaboration between different organisations to deliver person-centred care, may be necessary to meet this challenge.

Resource Constraints

Person-centred care is costly, although a necessarily costly investment in the valued lives of persons with dementia. To provide this care, finite resources including manpower, the state of the environment including physical facilities, and funding will need to be considered.

Implementing Person-Centred Dementia Care: Person-Centred Care Planning

In order to implement quality person-centred dementia care for persons diagnosed with dementia, care plans are formulated.

Care plans are extensions of medical records that are written records articulating care goals and action plans. They are living documents, that is, they are routinely reviewed and updated by care recipients, their next-of-kin, caregivers, and care professionals. Care plans aim to facilitate care that is individualised for these persons, coordinated across care teams, and well-documented.

For more information on person-centred care planning, find out at Person-Centred Care Plannin g.

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The Health Foundation. (2016, January). Person-centred care made simple. https://www.health.org.uk/sites/default/files/PersonCentredCareMadeSimple.pdf
Ibid.
Brooker, D. (2004). What is person-centred care in dementia?. Reviews in clinical gerontology, 13(3), 215-222.
Murdock, N. L. (2017). Theories of Counseling and Psychotherapy: A Case Approach (4^th ed.). New York: Pearson.
The Health Foundation. (2016, January). Person-centred care made simple.
Brooker, D., and Latham, I. (2016). Person-centred Dementia Care: Making Services Better with the VIPS Framework (2^nd ed.). Jessica Kingsley Publishers.
History of the spark of life model of care. Retrieved February 22, 2021, from https://dementiacareinternational.com/history-spark-life-philosophy/
Barback, J. (2014, March 10). Spark of life approach: is it the way to go? Healthcentral.nz.
Brune, K. (2011). Culture change in long term care services: Eden-Greenhouse-Aging in the community. Educational Gerontology, 37(6), 506-525.
Thomas, W. H. (1996). Life worth living: How someone you love can still enjoy life in a nursing home: The Eden Alternative in action. Publisher: Vanderwyk & Burnham.
Alzheimer’s WA. (n.d.). Models of Care. https://www.alzheimerswa.org.au/about-dementia/understanding-dementia-care/models-of-care/
Brune, K. (2011). Culture change in long term care services: Eden-Greenhouse-Aging in the community. Educational Gerontology, 37(6), 506-525.
Brooker, D., and Latham, I. (2016). Person-centred Dementia Care: Making Services Better with the VIPS Framework (2^nd ed.). Jessica Kingsley Publishers.
Ibid.
Heine, S. J. (2010). Cultural psychology. In S. T. Fiske, D. T. Gilbert, & G. Lindzey (Eds.), Handbook of social psychology (p. 1423–1464). John Wiley & Sons, Inc. https://doi.org/10.1002/9780470561119.socpsy002037
Geertz, C. (1973). The interpretation of cultures (Vol. 5019). Basic books.
Brooker, D., and Latham, I. (2016). Person-centred Dementia Care: Making Services Better with the VIPS Framework (2^nd ed.). Jessica Kingsley Publishers.
Ibid.
Balqis-Ali, N. Z., San Saw, P., Jailani, A. S., Fun, W. H., Saleh, N. M., Bahanuddin, T. P. Z. T., Sararaks, S., & Lee, S. W. H. (2021). Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory-Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers. BMC Health Services Research, 21(1), 1-12.
Bing-Jonsson, P. C., Slater, P., McCormack, B., & Fagerström, L. (2018). Norwegian translation, cultural adaption and testing of the Person-centred Practice Inventory–Staff (PCPI-S). BMC health services research, 18(1), 1-10.
Poland, F., & Birt, L. (2016). The agentic person: shifting the focus of care.
Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self‐management. Health Expectations, 17(3), 303-310.
Chenoweth, L., Stein-Parbury, J., Lapkin, S., Wang, A., Liu, Z., & Williams, A. (2019). Effects of person-centered care at the organisational-level for people with dementia. A systematic review. PloS one, 14(2), e0212686.
Ibid.
Kim, S. K., & Park, M. (2017). Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clinical interventions in aging, 12, 381.
Tew, C. W., Ong, S. P., Yap, P. L. K., Lim, A. Y. C., Luo, N., Koh, G. C. H., Ng., T.P., & Wee, S. L. (2021). QUALITY OF LIFE, PERSON-CENTRED CARE AND LIVED EXPERIENCES OF NURSING HOME RESIDENTS IN A DEVELOPED URBAN ASIAN COUNTRY: A CROSS-SECTIONAL STUDY. Jour Nursing Home Res, 7, 1-8.

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Reminiscence in Dementia Care

Admin — Sat, 08 Oct 2022 10:59:52 +0000

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Reminiscence is a method in dementia care that focuses on facilitating recollection about past events and experiences with persons living with dementia. This recollection creates opportunities to improve the wellbeing of persons with dementia, and for family and caregivers to meaningfully connect with them.

Reminiscence focuses on the discussion of activities, experiences, and events from the past. It is often referred to as “reminiscence therapy”, which is an umbrella term for different approaches to engage people in reminiscence for therapeutic purposes.^1,2

It is often done with older persons, including those with dementia and depression, and nearing the end of life.¹

Reminiscence therapy is closely linked to Robert Butler’s (1963) work on the process of ‘Life Review’³. In this work, Butler states that the experience of reviewing one’s life is universal (experienced by everyone). It involves a person looking back upon their life, reflecting on past experiences, including unresolved issues.

Butler’s work greatly influenced the conversation about reminiscence in dementia care. With this work, the concept of life review was brought into the field of psychotherapy for older persons to address the integrity and adjustments of these persons. His work also influenced how reminiscence is seen: not as a psychological dysfunction, but as a process that has the potential to be constructive.³

Butler’s work aligns well conceptually with Erik Erikson’s theory on the stages of psychosocial development, which details eight key stages of development people experience through their lifespan. In the eighth and last stage, Erikson theorises that people, usually in their later lives, experience a crisis of ‘ego integrity versus despair’. A person aims to find meaning and acceptance of their lives while reviewing their lives during this psychosocial stage.^4,1

Though Butler’s ‘Life Review’ focuses on an individual’s review of their own lives, different approaches to reminiscence work that do not focus on the life review process have developed since then.

Aims of Reminiscence Therapy

The aim of a reminiscence activity varies with the profile of the individual or group participating (e.g. age, health conditions), and the type of reminiscence work done.

Facilitators of reminiscence activities can also tailor their activities according to the specific goals of the person it is being done with (e.g. a person living with dementia and/or their caregiver) and the personnel conducting the activity.

Potential aims include the enhancement of communication skills, to increase a sense of personal or narrative identity11, have an enjoyable social activity, improve mood and quality of life, stimulate memories. Reminiscence can also be done to make care more individualised,² which aligns well with the aims of person-centred care.

Caregiver-related aims include: relieving caregiver burden, improving caregiver mental health, an improvement in caregiver loneliness, and improving the relationship between person living with dementia and the caregiver.

It is possible, though not guaranteed, that the achievement of some outcomes has ripple effects on other outcomes as well. For example, a person living with dementia who is encouraged to perform skills that they frequently engaged in during their earlier years may experience an increase in self-esteem, which may improve their mood and behavioural outcomes.

Evidence for outcomes

At present, there is emerging evidence that reminiscence therapy has the potential to improve some outcomes for persons living with dementia, including quality of life, communication, cognition, and mood.^1,2

Components of Reminiscence Therapy

In Macleod and colleagues’ study² on what happens in reminiscence therapy, common components (things done or used during therapy) were identified from a selection of studies.

Frequently used components included:

Memory triggers: The use of materials such as audio or visual programmes, images, sentences, or memorabilia to prompt a person to recall memories
Themes: A focus on themes such as food, music, pop culture, or places, during the activity.
Life stages: An exploration of the participant or participants’ life stages.
Reality Orientation: Prompting participants to understand their present reality, including their physical surroundings and time.
Activities: Activities for participants to participate in during the reminiscence session.
Family-only sessions: Sessions involving family members.

The benefits of the above components were compared across five outcome domains (cognition, mood, behaviours, quality of life, caregiver-related outcomes, and communication). It was found that, across the studies surveyed:

Memory triggers, and to a lesser degree themes, were found not to be consistently beneficial
The component “life stages” was linked to benefits in mood, quality of life, and caregiver-related outcomes
The component “activities” was linked to benefits in the behaviour of the person living with dementia, and caregiver-related outcomes
Family-only sessions was a beneficial component of reminiscence work for caregiver-related outcomes

Who can facilitate reminiscence work?

Reminiscence therapy is currently facilitated by trained care personnel from a variety of professional backgrounds, including health and social service practitioners.²

Concerns about the use of Reminiscence

Though reminiscence has its benefits, it should also be facilitated with care.

Painful memories: Recall of past events may involve the recollection of traumatic or painful memories (e.g. wartime memories, memories from difficult personal events). It is important that care personnel review the life history of the person living with dementia to facilitate activities with sensitivity.

The difficulty of recalling memories: Due to the increasing difficulty of persons living with dementia to intentionally recall memories, they might feel discouraged when experiencing such difficulties during reminiscence activities.

It is important that questions facilitators ask are open-ended and exploratory, instead of close-ended and test-like. When questions are phrased this way, it is easier for participants to recall memories relevant to the conversation topic as the scope of discussion is much wider than with a close-ended question. With this lower barrier to participation in the conversation, participants may feel more encouraged to participate.

Handling life reviews with sensitivity: Reviewing one’s life comes with appraising the meaning of past seasons of life. This can be challenging, even when done in private.

When a life review is done collaboratively with loved ones or care personnel, a person must take the additional steps of articulating their thoughts to others, while trusting others that they can be vulnerable and honest about their private thoughts and feelings. It is important that care personnel be sensitive and gentle in handling such conversations.

Conclusion

Reminiscence is a useful tool in dementia care. It can increase the wellbeing of persons living with dementia and their family by providing a means of engagement, while also presenting a meaningful opportunity for persons to meet their need to evaluate their lives.

Reminiscence components can be incorporated into other activities as well. Read about reminiscence-based activities and reminiscence arts to find out more about how reminiscence may be incorporated and adapted into activities.

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How Effective are Dementia Medications

Admin — Sat, 08 Oct 2022 09:04:29 +0000

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Medications, while with modest benefits, may be prescribed to relieve some symptoms and behaviour changes associated with dementia. However, ongoing debates over their effectiveness continue – the benefits and risks of the medications are discussed.

Three AChEIs are available in Singapore and all have demonstrated their efficacy in dementia management. Despite the slight variations in the mode of action, there is no evidence of difference in efficacy. The choice of an agent should be a shared decision between the clinician and care recipient as there are a variety of formulations and costs.

While AChEIs were developed for Alzheimer’s disease, evidence also supports the use of AChEIs in other types of dementia, such as vascular dementia, dementia with Lewy bodies, and Parkinson disease dementia, but not for prevention of progression of mild cognitive impairment to dementia.

Side Effects & Risks

Common adverse effects of AChEIs should be considered and counseled (Jackson, Ham, & Wilkinson, 2004):³

Gastrointestinal symptoms such as nausea, diarrhea and anorexia are the most common side effects of AChEIs. These adverse effects are commonly dose dependent.

AChEIs is contraindicated for individuals with known heart block or other cardiac conduction system diseases. Bradycardia is another common side effect of AChEIs, which could increase the risk of fall and syncope, especially among the older adults. Should patients develop significant bradycardia, AChEIs should be discontinued first while addressing other causes of bradycardia.

Evening doses of AChEIs could potentially enhance the activation of visual association cortex during REM sleep, which could cause insomnia and vivid dreams. People who experience sleep disturbances due to AChEIs could consider switching to morning dose.

NMDA Antagonists

Memantine

The mechanism of the action of memantine is distinct from cholinergic agents but not fully understood. It is hypothesized to improve signal to noise ratio, thereby ameliorating NMDA receptor function. There is some research to show it may also be neuroprotective.

A systemic review done in 2008⁵ showed that memantine shows benefits in cognition and on global dementia assessment, but with small effects that are of unclear clinical significance; improvement in quality of life and other domains are suggested but not proven. The benefits are seen mainly in patients with moderate to severe dementia, there is a lack of robust evidence in mild dementia.⁵

Memantine does not appear to have significant side effects. However, it should be used with caution in patients with a known history of seizures as it lowers seizure threshold and for individuals with chronic kidney disease, renal dosing is recommended.

Aducanumab

In 2021, Aducanumab, a recombinant monoclonal antibody is the first Food and Drug Administration (FDA) approved treatment for Alzheimer’s disease through the accelerated approval pathway. Aducanumab reduces the beta-amyloid plaques, which is the hallmark pathology of Alzheimer’s disease. At present, Aducanumab treatment is limited to persons living with mild cognitive impairment or mild dementia with documented amyloid pathology. APOE4 status check is recommended prior to the initiation of treatment as there is significant risk of amyloid-related imaging abnormalities (ARIA, can present as focal vasogenic oedema of the brain or intracranial hemorrhage) among APOE4 carriers.⁶ As there is still uncertainty with its clinical benefit, it is currently not available in Singapore.

Antipsychotic Drugs^7-10

Many best practice clinical guidelines all over the world have recommended for non-pharmacological interventions to be the first-line of treatment for behaviour changes and symptoms related to dementia. Where possible, non-pharmacological interventions should be attempted before using antipsychotic drugs to address the behaviours.
Antipsychotic drugs can be divided into typical (haloperidol) and atypical (quetiapine, risperidone, olanzapine, etc.). Antipsychotic drugs can be used for treatment of psychotic symptoms including hallucinations, paranoia and delusions when it is critical to the safety, well-being and quality of life of the person living with dementia and their caregiver.

Side Effects & Risks

The side effects include sedation, extrapyramidal disturbances, postural hypotension, QT prolongation, confusion, and falls. Antipsychotic medications are associated with an increased risk of stroke, myocardial infarction and death when used to treat behaviour changes in older adults living with dementia.
Caution needs to be exercised in the use of antipsychotics drugs especially in people living with dementia with Lewy bodies. They may be especially sensitive to antipsychotic medication and may experience idiosyncratic, life threatening adverse reactions.
In conclusion, it is essential to weigh the benefits of the antipsychotic medications in treating the behaviour changes compared to the potential adverse reactions in persons living with dementia. The antipsychotic medications should be maintained only if benefits are apparent, and discontinuation should be attempted at regular intervals.

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1. Treatments for Dementia
2. Tips to Manage Dementia Medications
3. Psychosocial Interventions in Dementia Care

References

1. Trinh, N. H., Hoblyn, J., Mohanty, S., & Yaffe, K. (2003). Efficacy of Cholinesterase Inhibitors in the Treatment of Neuropsychiatric Symptoms and Functional Impairment in Alzheimer Disease: A Meta-analysis. JAMA, 289(2), 210–216.
2. Feldman, H., Gauthier, S., Hecker, J., Vellas, B., Subbiah, P., & Whalen, E. (2001). A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology, 57(4), 613–620. https://doi.org/10.1212/WNL.57.4.613
3. Highlights of prescribing information – Aduhelm. (2021). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761178s000lbl.pdf
4. Jackson, S., Ham, R. J., & Wilkinson, D. (2004). The safety and tolerability of donepezil in patients with Alzheimer’s disease. British Journal of Clinical Pharmacology, 58(1), 1–8. https://doi.org/10.1111/J.1365-2125.2004.01848.X
5. Raina P, Santaguida P, Ismalia A (2008). Effectiviness of cholinesterase and memantine for treating dementia: evidence review for a clinical practice guideline
6. (Highlights of prescribing information – Aduhelm, 2021)
7. Corbett A, Burns A, Ballard C; Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia; BMJ. 2014; 349:g6420 Epub 2014 Nov 3
8. Reus VI, Foctmann Lj, Eyler AE; The American Psychiatric Association Practice Guidelines on the Use of Antipsychotics to treat Agitaiton or Psychosis in Patients With Dementia; Am J Psychiatty. 2016 Nay: 173(5):543-6
9. Antipsychotic drugs for dementia: a balancing act; Lancet Neurol. 2009:8(2):125
10. Sink KM, Hilden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005:293(5):596

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Person-Centred Care Planning in Dementia

Admin — Sat, 08 Oct 2022 08:18:40 +0000

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In this topic, the importance of developing a person-centred care plan for persons living with dementia is emphasised. This page also summarises some of the best practices for a person-centred care planning process and the elements that a good care plan entails. Having these in place will assist care professionals to then deliver quality person-centred care for their clients or patients living with dementia.

In this Article
What Is a Care Plan and Why Is It Important?
Care Plans in Singapore
Person-Centred Care Planning for Persons Living With Dementia
Individualised Care
Interdisciplinary Team Approach
Cyclic Process
First Person Language
Comprehensive & Holistic Assessments
Elements to Include in a Person-Centred Care Plan For Persons Living With Dementia
Life History
Personality, Lifestyle, Likes & Dislikes, Beliefs Systems
Cognitive Abilities & Impairments
Health Conditions
Relationships With Others
Financial, Legal History & Status
Goals of Care & Interventions
Additional Resources

What Is a Care Plan and Why Is It Important?

In health and social care, a care plan is typically used for an individual who receives care for different reasons. They might be hospital patients, and/or persons who use services for persons living with dementia, mental illness, or learning and development disability.

A care plan is usually a/an:

Extension of a medical and health record;
Written record (either electronic or paper-based) of the outcomes of a care planning process, where care professionals and recipients discuss and agree on an action plan to achieve a set of care goals that are of most concern to the needs and conditions of care recipients; and
Living document that is used, reviewed and updated routinely (ranging from once daily to every few months) by the care recipients, care professionals and/or others (i.e., care recipients’ families).^1,2

Care plans and care planning are essential as they serve the following purposes:

Individualised/ Personalised Care: They provide overall directions and detail the approaches that care professionals should use or personalise to the unique, individual needs, diagnosis and conditions of a care recipient;
Facilitate Continuity and Coordination of Care: They are means of communication on care information and delivery to facilitate continuity of care between different care professionals, across shifts, or even between two care settings. This helps to ensure that the care recipient continues to receive the same care regardless of the changes. Sometimes, the care interventions may also need to be carried out by two or more professionals and settings; and
Encourage Documentation of Care: Care plans function as documentation which outlines care recipients’ needs, conditions, and interventions. This documentation functions as a helpful guide to a multidisciplinary care team, when the client/patient may require attention from team members with specialised skills at different points of time.^2,3

A ‘gold standard’ care planning process should lead to the creation of a care plan, which in turn serves as a foundation and guide that feeds back into ongoing care planning and implementation.¹ Care plans are used in many healthcare systems all over the world, and each country may have its own set of requirements for the development of care plans.¹
Care plans for different mental conditions may look different, since the steps taken to address different conditions focus on different issues and strategies to address them. For example, care plans for individuals who suffer from chronic asthma are focused on daily management and step-up treatments in case of emergency situations and/or deterioration, where urgent medical interventions are needed.⁴ On the other hand, care plans for severe mental health conditions consist of both needs assessments and action plans, which focus more on the management of crisis situations should they occur.⁵

Care Plans in Singapore

In Singapore, the Ministry of Health (MOH) has developed service requirements and standards for centre-based services and nursing homes to follow when creating their respective care plans for clients and residents, including those living with dementia. These documents state that:
Upon admission, preliminary assessments and care plans should be administered and developed, respectively;
Clients’/residents’ assessments, care needs, goals of care, interventions, outcomes, and evaluation of care should be documented;
Ongoing comprehensive assessments are necessary; and
Care plans should be routinely evaluated and reviewed.

Refer to the Ministry of Health’s websites for the latest information on the requirements for care planning in Intermediate and Long-Term Care Services (i.e., Centre-Based Care Services, Home Care Services, Nursing Homes, etc.):
Home and Centre-Based Care Service Requirements

Person-Centred Care Planning for Persons Living With Dementia

As dementia is progressive, a person living with dementia will experience a worsening of symptoms, as well as a deterioration of their abilities over time. However, the most disabling effect of dementia is not the cognitive and functional impairments, but the implications on one’s self and personhood.⁶ With continual cognitive and functional decline, it becomes increasingly difficult for a person living with dementia to communicate about their needs and preferences. Thus, it may be easier for others to take control over their life and care. As a result, they may often be perceived as diminished beings, and be treated in non-humane ways, and as though they are no longer human beings.⁷
Professor Thomas Kitwood, the author of “Dementia Reconsidered: The Person Comes First”, advocated for the position that personhood consists of more than a person’s cognitive and functional abilities.⁸ Every person is a unique individual who has inherent dignity, including those living with dementia. This dignity remains with them throughout the course of their condition. Despite their diagnosis, persons living with dementia still have their own unique strengths, beliefs, values, life stories, personalities, preferences and needs. Furthermore, dementia manifests itself differently in every person living with dementia as well – no two persons develop the same exact symptoms.⁸
Each person should be treated with the respect a person is due. Similarly, they should be accorded with opportunities to interact positively with their physical and social environments, and to experience a good quality of life. It is essential for others around a person living with dementia to recognise that their personhood continues and find ways to uphold this personhood, even as their condition progresses. This person takes the uniqueness of each person, including their needs, wishes, perspectives, and preferences, into account. These ideas form the basis of person-centred dementia care.⁶ Additionally, as discussed in the article titled “Person-Centred Dementia Care“, provision of care with a person-centred approach brings about more positive effects than limitations not only to persons living with dementia, but also to care professionals and the care culture in the organisations involved. An optimal person-centred care plan lays the foundation for the delivery of good quality dementia care.⁹
When a person’s dementia progresses, it becomes increasingly challenging to discover their needs, wishes, perspectives, and preferences. However, person-centred care should continue to be carried out throughout the person’s experience of dementia, and there are ways of doing so.
The care planning journey may begin upon being diagnosed with dementia. As there is no “one size fits all” model of care, the key to a good person-centred dementia care plan should not just focus on effective management of dementia symptoms or activity engagement, but to build and tailor a unique plan around each person living with dementia. It is important for care professionals to take the time and effort to gather all the available information about the whole person in order to develop a comprehensive and individualized care plan for them. A well-researched and formulated care plan can serve as an important aid to care partners (care professionals and family members) to respect the individual living with dementia, and ensure quality person-centred care is delivered. It can also help everyone around to build better relationships with and understand the person as a whole, and use it to meet their needs and desires.⁹
The list below is a consolidation of recommendations from several requirements and toolkits, on some best practices employed during a good person-centred care planning process for individuals living with dementia:^9,10

Individualised Care

A good care plan for individuals living with dementia should look at the whole person, and comprise details on all areas of the individual’s life. It should focus not only on the person’s physical health aspects, but also on their emotional and social aspects as well. More importantly, an optimal care plan will include how staff can effectively address this wide range of the person’s needs and preferences.
Additionally, the care plan should emphasise a person’s strengths and abilities rather than disabilities, and how staff can promote their best interests and strengths. In this way, this person-centred care plan is more likely to be translated into good care practices, which can support and maintain a person’s independence and autonomy despite their dementia.

Interdisciplinary Team Approach

Mutually beneficial relationships and good communication between persons with dementia and their care partners (family caregivers and care professionals) are crucial in building a comprehensive person-centred dementia care plan. It is important for all the stakeholders to be meaningfully and fully involved, and provide their inputs throughout a care planning journey. The initial and ongoing collaboration between the person living with dementia, their family members and friends, and the care team is key to delivering quality person-centred care outcomes. A good care plan will emphasise teamwork by all stakeholders and on everyone’s responsibilities in putting the plans to practice.
As persons living with dementia know themselves best and are experts in their own health and well-being, they should be treated as equal and active partners in the creation and review process of their care plans. Similarly, they should be placed at the centre of the decision-making process and encouraged to participate in decisions involving areas of their care and intervention strategies. In this way, care plans can then be personalised to their individual strengths, preferences, values and cultures. This also ensures that the care solutions and interventions developed can successfully support their health and well-being and best meet their needs.¹¹
Family members and/or friends are likely to have had an extended period of sharing personal experiences together with the person living with dementia before their diagnosis. They may thus be able to contribute much useful information about the person, especially when they are in the advanced stage of dementia and have difficulties communicating. Understanding how the dynamics with these family members/friends have developed over the years helps care professionals to gain a more holistic picture of the person living with dementia. In addition, family members and friends who are caregivers also require support as they carry out caregiving responsibilities. Their wishes should be taken into consideration during care planning too. Being aware of and understanding the goals of care can allow family members to support care professionals to achieve their goals with the person living with dementia.
Care Professionals: Persons living with dementia can have multiple needs and care goals that require attention and support from a team of various care professionals with different sets of specialised skills. Each team member may be responsible for a specific care goal, or be required to exchange information with one another while working together to deliver care. Furthermore, when persons living with dementia are unable to speak, the care team needs to collaborate to understand the person’s needs and preferences in order to develop an effective care plan.

Cyclic Process

As mentioned earlier, a ‘gold standard’ of the care planning process should result in the creation of a care plan, which feeds back into an ongoing care planning and implementation process.
Individuals’ likes and dislikes can change over time, and so do those of persons living with dementia. Care professionals have to be flexible in meeting these changing preferences and needs, and frequently plan for alternative scenarios and potential changes. To adapt to these changes, a person-centered care plan for persons living with dementia has to function as a living document that is updated as often as the person’s needs and preferences change. Similarly, having a completed, accurate, and up-to-date profile would enable both persons living with dementia, as well as their care partners to effectively participate in care planning and decision-making, in order to receive the most appropriate care.
To achieve the above, it is recommended that an optimal person-centred care plan should include a cyclical process. Hence, after the creation of the care plan, this plan should also be routinely reviewed and modified. It should also be updated whenever there is a change to a person’s demeanour. This involves a routine gathering, dissemination and re-assessment of information about the person living with dementia. This will subsequently enable the care team to continually develop and implement updated care solutions and interventions for them. Having the above proposed ongoing cyclic process in place will further ensure that quality person-centered dementia care, well-coordinated, and readily provided. It also ensures continuity of care, since care professionals who take over the care of the person living with dementia have access to the same set of documented information as previous care professionals working with the person. It is therefore beneficial to formalise this system, to facilitate the operationalisation of this cyclical process.

First Person Language

A person-centred care plan should provide a voice for the person living with dementia, especially at the later stages when they experience difficulties in language and communication. Hence, their perspectives should be incorporated as much as possible. Writing the care plan in first person (as if the person is speaking), with personal statements and information included, may enhance the experience of the person living with dementia, by presenting to care partners a more personal account of who they are. Some examples of these personal details include the preferred name that they would like others to use, and their strengths and interests. A good person-centred care plan that incorporates the elements recommended above can be helpful to care professionals, especially for those who are new to the person living with dementia, in understanding them as a whole person. Care professionals referring to this care plan will know what is expected of them when working with the individual too.^8,12

Comprehensive & Holistic Assessments

At the beginning of a person-centred care planning process, a person living with dementia and/or their family has to work together with care professionals to complete an initial holistic assessment around him/her, evaluating all areas related to his/her well-being and health. The findings can then be translated and included into an informative dementia care plan.¹³ Subsequently, this evidence-based care plan is constantly updated according to findings which are regularly gathered from ongoing, comprehensive assessments, including evaluation results of the impact of care interventions and solutions.¹¹
The following are some examples of information collected through assessments that allow care professionals to learn about the holistic health and well-being of a person living with dementia:
• Personal information from both past and present such as:
⇒ Life stories,
⇒ Physical health and abilities in activities of daily living,
⇒ Strengths and interests,
⇒ Preferences, likes and dislikes,
⇒ Personalities,
⇒ Lifestyles,
⇒ Beliefs and values, and
⇒ Mood, behavior and cognition;
• Physical and social environment;
• Plans for end-of-life care; and
• Needs, including physical, psychological, spiritual and social needs, etc.
These assessments’ results can be included in the person’s dementia care plan, which will then be able to support care professionals to:
• Review and set realistic goals that promote the person’s health and quality of life;
• Evaluate the outcomes and impact of care solutions and interventions on attaining the person’s care goals; and
• Enhance existing or develop new interventions that appropriately meet the person’s needs, align with their preferences, and maintain their strengths.
Read further on the various assessments that care professionals may use to measure and gather information on the multiple aspects and needs of persons living with dementia.

Elements to Include in a Person-Centred Care Plan For Persons Living With Dementia

This section lists down some examples of information to gather and document under the multiple components that can be incorporated in a person-centred dementia care plan.

Life History

• A description of the person
• Name and the preferred name to be called by others
• Date of birth
• Genogram and ecomap
• Language(s) spoken/previously spoken, preferred language(s)
• Health and social care organisations involved in person’s care
• Significant life events, such as:
⇒ Life and death events
⇒ Marriage
⇒ Relationship issues and divorce ⇒ Education history
⇒ Events in life of family and friends
⇒ Life in different neighbourhoods, cities, or countries
⇒ Cultural or religious events important to the individual
⇒ Work history and changes in occupation
⇒ Both proud and difficult times
⇒ Traumas

• When do memories and anniversaries of these occasions affect the person’s emotions, behaviour, and cognition?
• How have these past experiences changed their life and affect how they make sense of what is happening in the present?

Personality, Lifestyle, Likes & Dislikes, Beliefs Systems

• Personality
• Lifestyle
• Strengths and abilities
• Personal possessions for everyday use
• Routines – daily, weekly, monthly, and yearly
• Likes and dislikes
• Things that he/she enjoys and does not enjoy
• Preferences and needs
• Religious or spiritual beliefs

• Cultural background
• Financial habits
• Stressors that can trigger them or push their boundaries
• Coping system or values during stressful situations
• How do they view and interpret things in the world and everything happening around them?
• Preferred daily routine, before and after being diagnosed with dementia
• Wishes that they had hoped to fulfill by the end of life

Cognitive Abilities & Impairments

• Dementia Diagnosis – The type and stage of dementia
• The effects of dementia have on cognitive abilities, such as:
⇒ Memory
⇒ Orientation to time, place and people
⇒ Processing information
⇒ Language
⇒ Understanding spoken and written language
⇒ Planning a course of action
⇒ Abstract thinking
⇒ How do these impairments affect a person’s abilities to carry out his/her activities of daily living (for e.g., shopping or dressing)?

• Any behavior changes associated with dementia
• Remaining cognitive abilities that are retained, such as:
⇒ Engaging in humour
⇒ Experiencing emotion
⇒ Exploring the environment
⇒ Seek meaning

Health Conditions

Co-occurring health conditions, such as:

• High blood pressure
• Heart diseases
• Acute confusional states from physical conditions, like infections, constipation, dehydration, malnutrition, which persons with dementia may be more susceptible to
• Pain
• Sensory impairments
• Safety and areas of high risk

• Mobility
• Toileting
• Eating patterns, dietary restrictions
Note: Some persons with dementia may have difficulties articulating changes to their health due to memory and language problems. Their care partners must thus be vigilant to consider that it is an underlying physical health condition affecting a person’s abilities rather than his/her dementia – not every change is attributed to dementia.

Relationships With Others

• Next-of-kin
• Caregiver(s) and previous caregivers
• Relationships that are supportive and damaging to them – family dynamics and situations, friendships, or familiar figures in the community or care environment (This is related to the genogram/ecogram – refer to the “life history” section above)

• Conflict resolution strategies between persons with dementia and their care partners (for e.g., any actions that may cause conflict and the patient’s views on how to resolve conflict most effectively)
• Social circumstances
• Relationships with social groups and organisations
• Preferred environment

Financial, Legal History & Status

• Citizenship and immigration status
• Whether this person have a donee under a lasting power of attorney, or a deputy
• Whether this person has a will
• Advance Care Plan

• Advance Medical Directive
• Financial and legal wishes
• Legal contacts
• Contact of representative social worker

Goals of Care & Interventions

Both short- and long-term goals, and the action plans to achieve them:

• As much as possible, providing a detailed description of the current status, functioning and/or unmet needs of the above components, will be ideal.

• From the descriptions, the person living with dementia or his/her family and the care team will then be able to:
⇒ Set realistic goals and outcomes, including the dates for completion of each goal;
⇒ Plan the therapeutic interventions and activities to meet the goals and needs; and
⇒ Inform the responsible discipline(s) and/or staff to follow up and monitor.

Additional Resources

Below is a consolidated list of resources which may serve as a good starting point for care professionals, and health and social care institutions in the development of a person-centred care planning process and care plan for persons living with dementia.

Best Practice Guidelines Underpinning Person-Centred Care Planning Process

The Wisconsin Department of Health Services, Bureau of Aging and Disability Resources in the United States has developed a set of guidelines for long term care settings to identify key strengths and potential areas for improvement in the following nine areas, including care plans:
Environment
Language and communication
Care Plans
Activities
Problem solving processes for working with behavioural communication
Communication and leadership
Team structure and roles
Staff knowledge and training
Policies and procedures

The Alzheimer’s Association created Dementia Care Practice Recommendations derived from a review of research literature, including Care Planning. These recommendations can be applied to all settings, types, and stages of dementia. The target audience for these recommendations are care professionals.
Person-Centred Care
Detection and Diagnosis
Person-Cented Assessment and Care Planning (Read more about this set of recommendations here.)
Information, Education, and Support for Individuals Living with Dementia and their Caregivers
Care of Behavioral and Psychological Symptoms of Dementia, and Support for Activities of Daily Living
Staffing
Supportive and Therapeutic Environments
Transitions in Care

The National Health Service of England developed a guide for primary care professionals and physicians that is designed to standardise and improve the care planning process to support persons living with dementia, by highlighting some of the good practices.

This guide developed by the Mental Welfare Commission for Scotland aims to help care professionals working in health and social care settings that serve persons and their caregivers who use dementia, mental health and learning disability services. This guide talks about the underlying principles of care planning and provides best practice suggestions for developing person-centred care plans.

Social Care Institute for Excellence advocates for the position that a good person-centred care plan is essential in protecting a person’s basic human rights, freedom and choices when individuals are at their most vulnerable. This resource demonstrates how the care planning process can embed and comply with the principles of the United Kingdom’s Mental Capacity Act to protect individuals who lack or have fluctuating capacity to make decisions, especially when it comes to their own care, life, and death. This report emphasises that even when a person lacks or has fluctuating capacity, the care plan in place should maximize their freedom to make decisions about their own care, and help to make decisions in their best interest and protect their human rights even when they are deprived of their liberty.

Toolkits to Help Gather Information on All Aspects of a Person’s Life and Develop a Person-Centred Care Plan

Enriched Care Planning for People with Dementia: A Good Practice Guide for Delivering Person-Centered Care

May, Edwards & Brooker (2009) shows in detail how to plan care by taking into account the perspectives of a person living with dementia. It presents and provides:

Using the Enriched Model of Dementia8 to develop an enriched care plan;

The five stages of enriched care planning;

How communication is key to the ongoing process of profiling a person living with dementia

An Enriched Profile and Care Plan template to document all the information gathered about a person living with dementia, and to plan and develop the person’s needs and care partners’ person-centred follow-up actions and interventions;

On top of the Enriched Profile and Care Plan template, this book offers additional profiling templates which lists out questions that care professionals may use to ask the person living with dementia and/or their loved ones, in order to gather all the information to profile the person. These templates include:

⇒ Life story profiling template ⇒ Lifestyle and future wishes profiling template ⇒ Personality profiling template ⇒ Health profiling template ⇒ Capacity for doing profiling template ⇒ Cognitive ability profiling template ⇒ Life at the moment profiling template

Care professionals can photocopy these templates to use in their work; and

Real case examples to illustrate the care planning process.

The Alzheimer’s Society created a leaflet titled ‘This is me’ that care professionals can use in any setting (at home, in hospitals, or long-term care settings) to gather and record the following information about a person, in order to better understand who the person is and provide the care that is individualised to their needs:
Cultural and family background
Important events, people and places from their life
Preferences, routines and habits
Communication and mobility

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References

Burt, J., Rick, J., Blakeman, T., Protheroe, J., Roland, M., & Bower, P. (2014). Care plans and care planning in long-term conditions: a conceptual model. Primary health care research & development, 15(4), 342-354. https://doi.org/10.1017/S1463423613000327.
Mental Welfare Commission for Scotland. (2019). Person centred care plans: Good practice guide. https://www.mwcscot.org.uk/sites/default/files/2019-08/PersonCentredCarePlans_GoodPracticeGuide_August2019_0.pdf
LeadingAge Center for Aging Services Technologies. (2016). Shared care planning and coordination for long-term and post-acute care: A primer and provider selection guide 2016 [White paper]. https://www.leadingage.org/sites/default/files/Shared_Care_Planning_and_Coordination_Whitepaper.pdf
Gibson, P. G., & Powell, H. (2004). Written action plans for asthma: An evidence-based review of the key components. Thorax, 59(2), 94-99. doi: 10.1136/thorax.2003.011858.
Goodwin, N., & Lawton-Smith, S. (2010). Integrating care for people with mental illness: The care programme approach in England and its implications for long-term conditions management. International journal of integrated care, 10, https://doi.org/10.5334/ijic.516
Kitwood, T., & Bredin, K. (1992). Towards a theory of dementia care: Personhood and well-being. Ageing and Society, 12(3), 269-287. https://doi.org/10.1017/S0144686X0000502X
Fazio, S. (2008). The enduring self in people with Alzheimer’s: Getting to the heart of individualized care. Baltimore, MD: Health Professions Press.
Kitwood, T. (1997). Dementia reconsidered: The person comes first. Buckingham: Open University Press.
Commission for Social Care Inspection. (2008). See me, not just the dementia: Understanding people’s experiences of living in a care home. https://staging.dementiaroadmap.info/wp-content/uploads/seemenotjustthedementia.pdf
The Wisconsin Department of Health Services Bureau of Aging and Disability Resources. (2014). Person-directed dementia care assessment tool: A guide for creating quality of life and successfully refocusing behavior for people with Alzheimer’s disease and related dementia in long term care settings. https://www.dhs.wisconsin.gov/publications/p2/p20084.pdf
National Health Service. (n.d.). Personalised care and support plan. https://www.england.nhs.uk/ourwork/patient-participation/patient-centred/planning/
Allen, K. (2020, January 16). Developing a dementia care plan. BrightFocus Foundation. https://www.brightfocus.org/alzheimers/article/developing-dementia-care-plan
Care Fit for VIPS Partnership. (n.d.). Care Fit for VIPS. https://www.carefitforvips.co.uk/
May, H., Edwards, P., & Brooker, D. (2009). Enriched care planning for people with dementia. London and Philadelphia: Jessica Kingsley Publishers.
South West Dementia Partnership. (2010). Person centred support plan for people with dementia. https://dementiapartnerships.com/wp-content/uploads/sites/2/person_centred_dementia_support_plan_A4.pdf

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Tools for Dementia Practice and Research

Admin — Thu, 29 Sep 2022 05:44:38 +0000

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With the rising incidence and prevalence of dementia worldwide that is projected to continue, more efforts have been invested to address the needs of persons living with dementia and individuals around them. One such effort is the development of assessment tools and instruments in the field of dementia care.
Some uses of the assessments include:
Measuring the progress of dementia-related impairments (cognitive, functional), or
Measuring the effects of dementia treatments in clinical trials, and
Evaluating the impact of psychosocial interventions in enabling persons living with dementia to live well, amongst other assessments.¹

Other than studying dementia assessment tools and instruments, researchers and clinicians also study the reliability and utility of the methods for validating and reporting dementia assessment tools and instruments. An ideal measure should be valid, reliable and practical to use. It should not use too much of the assessors’ and participants’ time.
In addition, as dementia may, from its earliest stages, affect cognition and language abilities, it is important to have both persons living with dementia and their proxies, such as family caregivers and care professionals, involved in the assessment process.² All these factors should be taken into consideration when choosing an assessment or instrument to be used in dementia care and research.
Singapore’s Ministry of Health (MOH) has developed a set of Clinical Practice Guidelines on Dementia. These guidelines list a number of recommended assessment tools to be used for cognitive screening, ratings of behaviour changes, and assessment of functional status and of social issues for persons at risk of dementia, for the process of diagnosis, and for persons who have been diagnosed with dementia.³
In the following nine documents, studies of some existing measures in dementia care have been consolidated and organised according to the purposes, strengths and limitations, and psychometric properties of the measures. You can find the embed links to the original journal articles and assessments/instruments in these articles for your further reading.

Tools & Resources

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Measuring Person-centredness of Care
Person-centred Care (PCC) is a philosophy that views individuals using healthcare and social services as equal partners in planning, developing, assessing, and monitoring care to ensure it meets their needs.
This resource lists and provides information about existing measures of PCC in the context of dementia care.
These measures include the Dementia Care Mapping tool, VIPS Assessment Tool, and Person-Directed Dementia Care Assessment Tool.

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Cognitive Assessments and Screening Tests
This resource lists and provides information about cognitive assessment and screening tools. These tools are used to both identify individuals showing symptoms of dementia and to monitor the progress of cognitive deterioration.
These measures include the Singapore version of the Abbreviated Mental Test (AMT), the Mini Mental State Examination (MMSE), and the Singapore version of the Montreal Cognitive Assessment (MoCA).

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Measures for Stages of Dementia
Dementia is a progressive condition, and in the field of dementia care, there are different systems available to measure, describe, and classify the progress of an individual person’s condition.
This resource lists scales that both measure aspects of a person’s condition and classify the progression of their condition into stages in their classification systems.

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Measures for Basic and Instrumental Activities of Daily Living (ADLs)
Basic and instrumental activities of daily living (ADLs) are tasks one must perform to function in everyday life. This resource lists and provides information about tools used to measure the degree to which a person can perform everyday tasks. Some of these tools are designed for use with persons living with dementia, and some for use beyond this specific population.
The scales listed include the Bristol Activities of Daily Living Scale (BADLS), Shah Modified Barthel Index (MBI), and Pool Activity Level (PAL) Checklist.

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Pain Measures for Persons with Advanced Dementia
This resource lists observational pain measures (pain measures that require observing a person’s behaviour) that are more appropriate for persons with limited communication abilities.
These include the Abbey Pain Scale, Non-Communicative Patient’s Pain Assessment Instrument (NOPPAIN), and the Checklist of Nonverbal Pain Indicators (C.N.P.I.).

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Measures for Behaviour Changes
Behaviour changes often happen as the condition of the person living with dementia changes. Some common changes in behaviour observed as dementia progresses include sleep disturbances, repetitive speech or actions, or a loss of behavioural inhibitions.
This resource lists and provides information about instruments used to assess behaviour changes in the field of dementia care.

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Measures on the Quality of Life of Persons Living with Dementia
This resource lists instruments used in the field of dementia care to measure the quality of life of persons living with dementia, or instruments used to measure constructs related to quality of life.
These instruments include the Dementia Care Mapping (DCM) tool, the Bradford Well-being Profile (WBP), the Bath Assessment of Subjective Quality of Life in Dementia (BASQID), and the Dementia Quality of Life Measure (DEMQOL).

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Measures on Dementia Caregiving
This resource lists and provides information about existing measures of various aspects of caregiving, including caregiver stress, caregiver burden, caregiver gains, the meaning caregivers find through caregiving, caregiver competence, and caregiver self-care self-efficacy, in the context of dementia care.
These measures include the Gain in Alzheimer care INstrument (GAIN) scale, the Short Form Zarit Burden Interview (ZBI-12), and the Sense of Competence Questionnaire.

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Measures on Dementia Attitudes & Knowledge
This resource lists and provides information about measures of attitudes that persons in general have towards dementia and what they know about the condition.
These measures include the Dementia Attitudes Scale (D.A.S.), Dementia Knowledge Attitude Scale (D.K.A.S.), and Knowledge in Dementia (K.I.D.E.) Scale.

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Dementia Care Training for Care Professionals

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Dementia-Inclusive Design Principles

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Person-Centred Care Planning in Dementia

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Reference

1. Burns, A., Lawlor, B., & Craig, S. (2002). Rating scales in old age psychiatry. The British Journal of Psychiatry, 180(2), 161–167. https://doi.org/10.1192/bjp.180.2.161
2. Sheehan, B. (2012). Assessment scales in dementia. Therapeutic Advances in Neurological Disorders, 5(6), 348–358. https://doi.org/10.1177/1756285612455733
3. Singapore Ministry of Health. (2013, July 10). Dementia: MOH Clinical Practice Guidelines 1/2013. Person-directed dementia care assessment tool. https://www.moh.gov.sg/docs/librariesprovider4/guidelines/dementia-10-jul-2013—booklet.pdf

The post Tools for Dementia Practice and Research appeared first on DementiaHub.SG.

Dementia Care Principles Archives - DementiaHub.SG

Recognising and Responding to Abuse in Dementia Care

In this Article

Types of Abuse

1. Physical Abuse

2. Emotional Abuse

3. Neglect and Self-Neglect

4. Financial Abuse

5. Sexual Abuse

Recognising Abuse in Dementia Care

Why Is It Crucial to Recognise Abuse?

Signs and Symptoms of Abuse

Risk Factors for Abuse in Dementia Care

Responding to Abuse

Ensure Immediate Safety

Document and Gather Evidence

Report the Abuse

Follow-up and Support

Conclusion

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Understanding the Four Pillars of Humanitude

What is Humanitude™?

Benefits of Humanitude

Applying the Four Pillars of Humanitude: Do's and Don'ts

Do's

Don'ts

Do's

Don'ts

Do's

Don'ts

Do's

Don'ts

Conclusion ​​

AUTHOR BIO

HUMANITUDE SINGAPORE

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Dementia Care Training for Care Professionals

Foundational Level

1. Agency for Integrated Care

Dementia Awareness: Foundation Level

Basic Level

1. Agency for Integrated Care

Dementia Care Basic Level – Person-Centred Care and Behaviours of Concern

Dementia Care Basic Level – The Brain and Understanding of Dementia

Dementia Care Basic Level – Enriching Lives

2. Dementia Singapore

A. Understanding Dementia – Nature & Impact*

B. Introduction to Person-Centred Care*

C. Behavioural Communication in Dementia*

D. Purposeful & Meaningful Engagement in Dementia Care*

E. Palliative Approach to Dementia Care*

F. Enabling EDIE (Educational Dementia Immersive Experience)

3. Kwong Wai Shiu Hospital

ITE Skills Certification in Healthcare – Dementia Care (Basic)

4. St. Luke’s ElderCare

Care of Client with Dementia (Basic)

Intermediate Level

1. Dementia Singapore

A. Integrated Care for Dementia (Intermediate)

B. Implement Namaste Care (Intermediate)

C. Reminiscence Arts for Dementia

D. Dementia Care Mapping (DCM) for Realising Person-Centred Care

2. St. Luke's ElderCare

Care of Client with Dementia (Intermediate)

3. St. Luke's Hospital

Becoming Dementia Care Ready! (Intermediate)

4. The Palliative Care Centre for Excellence in Research and Education (PalC)

Geriatric Palliative Care in Advanced Dementia

Advanced Level

1. Dementia Singapore

Conclusion

Dementia Care Basic Level –
Person-Centred Care and Behaviours of Concern

Dementia Care Basic Level –
The Brain and Understanding of Dementia

Dementia Care Basic Level –
Enriching Lives