Planning & Implementing Care Archives - DementiaHub.SG https://www.dementiahub.sg/dementia-practice/planning-implementing-care/ Singapore’s One-Stop Resource Portal on Dementia Wed, 25 Mar 2026 03:25:31 +0000 en-US hourly 1 https://www.dementiahub.sg/wp-content/uploads/2022/06/fav.png Planning & Implementing Care Archives - DementiaHub.SG https://www.dementiahub.sg/dementia-practice/planning-implementing-care/ 32 32 Recognising and Responding to Abuse in Dementia Care https://www.dementiahub.sg/dementia-practice/recognising-and-responding-to-abuse-in-dementia-care/ Tue, 18 Feb 2025 15:59:59 +0000 https://www.dementiahub.sg/?post_type=dementia&p=65469 Listen Min Read 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 […]

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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: 

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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References

  1. Straits Times. (2023, May 31). Slight rise in elder abuse cases; caregiver stress is a common factor behind abuse. The Straits Times. Retrieved from https://www.straitstimes.com/singapore/slight-rise-in-elder-abuse-cases-caregiver-stress-is-a-common-factor-behind-abuse
  2. HelpGuide. (n.d.). Elder abuse and neglect: Recognising and responding to elder abuse. HelpGuide.org. Retrieved from https://www.helpguide.org/aging/healthy-aging/elder-abuse-and-neglect
  3. Ministry of Social and Family Development. (n.d.). Protecting the vulnerable. Office of Public Guardian. Retrieved from https://www.msf.gov.sg/what-we-do/opg/safeguards/protecting-the-vulnerable 

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]]> Understanding the Four Pillars of Humanitude https://www.dementiahub.sg/living-well-with-dementia/understanding-the-four-pillars-of-humanitude/ Sat, 07 Sep 2024 03:02:42 +0000 https://www.dementiahub.sg/?post_type=dementia&p=56679 Listen Min Read As dementia progresses, the needs of those living with the condition evolve, requiring caregivers to adapt and find new ways to

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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.

Watch video

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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]]> Responding to Behaviour Changes using the ABC approach https://www.dementiahub.sg/dementia-practice/responding-to-behaviour-changes-using-the-abc-approach/ Mon, 22 Jul 2024 11:57:33 +0000 https://www.dementiahub.sg/?post_type=dementia&p=54285 Listen Min Read Behavioural and Psychological Symptoms of Dementia (BPSD) often present significant challenges, impacting both the person with dementia and those providing care.

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Behavioural and Psychological Symptoms of Dementia (BPSD) often present significant challenges, impacting both the person with dementia and those providing care. This article delves into common manifestations of BPSD and introduces the ABC approach—a structured method to analyse and manage these symptoms effectively.

Persons living with dementia may experience behavioural and psychological symptoms of dementia (BPSD) which can include symptoms of disturbed perception, thought content, mood, or behaviour. Here are some examples of BPSD that are commonly seen in persons living with dementia:

One of the ways to manage and reduce the occurrence of BPSD is to utilise the ABC approach.

What is the ABC approach?

The ABC approach is a simple and effective method for understanding and managing behaviour changes by analysing the triggers, actions or responses, and outcomes associated with those behaviours:

A = Antecedents
B = Behaviour
C = Consequences

It allows for the observation of events leading up to a change in behaviour, as well as the immediate and long-term effects of that behaviour.  

By breaking down behavioural events into these components, caregivers can gain insights into why these behaviours occur and develop targeted strategies to support persons living with dementia to reduce the impact and frequency of BPSD. 

Let’s dive deeper into each of the steps of the ABC approach.  

Antecedents

Antecedents are events or factors that precede the behaviour change and contribute to its occurrence. Antecedents are also called “triggers” because they “set off” behaviours. When reviewing these events, it is important to take note of the following points:

1. When and where did the behaviour occur?
2. What was the person living with dementia doing right before the behaviour occurred?
3. What was happening around the person living with dementia at that time?
4. Consider environmental factors that might influence their behaviour.
  • Does the environment provide a safe place for the person living with dementia to walk around? 
  • Does it encourage independence, dignity and mobility? 
  • Does it accommodate their personal cultural and lifestyle habits? 
  • Other factors include:   
    • Noise 
    • Clutter  
    • Bright lights/glare on the floor 
    • Mirrors 
    • Temperature 
    • Recent changes to the environment 
5. Consider the following physical factors: 
  • Basic needs:  
    • Hunger, fatigue, constipation/faecal impaction 
  • Recent change in medical condition:  
    • Metabolic: Hyper/hypo thyroidism, hypercalcemia, hyponatremia 
    • Infection: Urinary tract infection, pneumonia, septicaemia 
    • Traumatic: Chronic pain, head trauma, fractures  
    • Systemic: Hypoglycaemia, Vitamin B12 deficiency, folate deficiency  
  • Medication:  
    • Sedatives, antihistamines, polypharmacy 
6. Consider the following psychological factors: 
  • History of psychiatric illness e.g. schizophrenia
  • Recent loss or accumulation of losses
  • Response to delusions or hallucinations

CAUSEd is a problem-solving tool developed by Dementia Australia to enable caregivers and care professionals to identify possible triggers of behaviour changes. Find out more about CAUSEd here. 

Behaviour

“Behaviour” in the ABC Approach refers to the specific behaviour change that needs to be addressed. Those behaviours that are of immediate concern would be those that risk harm to the person living with dementia or others or have a negative impact on the quality of life of the person living with dementia and/or their caregivers. Look at one behaviour at a time in the problem-solving process.

1. What was the behaviour of the person living with dementia?

Be as specific as possible. For example, if the person living with dementia is displaying signs of aggression, be specific to describe the presenting behaviour. Examples of specific presenting behaviours include, using the umbrella to hit the caregiver, shouting vulgarities, throwing a cup at the caregiver.

2. It is also critical to identify the frequency, scope, and duration of such behaviours.

Consequences

These refer to the events that happen immediately after the behaviour occurs. It also includes all the reactions and responses to the person living with dementia, including those by the caregiver, other family members, staff or visitors.

1. How did others respond to the change in behaviour?
  • Ignored the person living with dementia 
  • Reprimanded the person living with dementia  
  • Tried to correct the person living with dementia 
  • Restrained the person living with dementia 
  • Sedated the person living with dementia 
2. What was the response of the person living with dementia to the reactions of others?
  • Annoyed 
  • Upset 
  • Angry  
  • Offended  

We must remember that persons living with dementia are unable to control and/or prevent these behaviours on their own.  So, what we can do or respond is to change or adjust what happens before (antecedents) or after (consequences) the behaviours. And it is recommended to change one antecedent or consequence at a time so that we can evaluate what is working and what is not. It is also important to note that the condition of the person living with dementia may deteriorate with time, therefore the same strategies may not always work. Modifying the environment (physical and social) over time might be necessary. 

Keeping a Behaviour Log

When dealing with behaviour changes, we can observe or reflect on the behavioural patterns of the person living with dementia during these stressful situations. One of the things that you can do is to monitor changes in behaviour with a behaviour log. By keeping a behaviour log, we may be able to find out what works to prevent or de-escalate the behaviour. Apply Person-Centred Care (PCC) to identify the unmet needs which may exacerbate the behaviour of concern, and make adjustments to the antecedents or consequence in order to address possible unmet needs related to attachment, comfort, occupation, identity and inclusion. 

Here is an example of an ABC Behaviour Log that can be used to help you observe and record these behaviours efficiently: 

Table 1. Extract from Mary’s ABC chart (Sample)
Date & Time

A = Antecedent (Triggers)

What happened immediately before the change in behaviour?
– Who was involved?
– What activity was going on?
– When did the behaviour occur?
– Where did the behaviour occur?
– How (in what way or manner?)
(Consider any potential unmet needs)

B = Behaviour

What was the behaviour you would like to change?
– Describe the behaviour observed i.e. yelling, kicking, swearing.
– What happened?
– How long did it last?
(Do not try to guess emotions)

C = Consequences (Responses)

What happened after the behaviour occurred?
– How did the person living with dementia respond?
– How did others around the person respond?
– Who else was involved?

1/7/2024, 5pmMary was playing mahjong with other residents and seemed very engrossed in the session. As it was dinner time, staff nurse Peter abruptly stopped the mahjong session. Mary was visibly upset and started scolding vulgarities at Peter. She said, “I was about to win and you cleared all the tiles! You are so bad!”When her dinner plate was served to her, Mary said firmly that she did not want to eat. When the staff tried to persuade her by scooping food for her and bringing to her mouth, Mary threw her dinner plate onto the floor and continued to spew vulgarities towards the staff.Mary tried to walk out of the dining area but was stopped by Peter. Another staff, Maryanne, came over to assist and both of them eventually brought her to her bed and gave her a radio to listen to. Mary was observed to have calmed down a little but was still visibly upset.
1/7/2024, 8pmStaff nurse Peter told Mary that it is time to go to the toilet and to change her diaper. However, Mary shouted, “No, I am not in the mood today. Do not bother me. You better get stay out of my sight!”Mary refused to go to the toilet for her diaper change. She scolded Peter when he attempted to assist her from her bed to the toilet.Mary kept shaking her head vigorously and tried to hit Peter multiple times. She was eventually physically restrained by two staff to the bed. Diaper change was done on the hospital bed.

Download the ABC Behaviour Log here.

Conclusion

The ABC approach can enable caregivers to monitor behaviour changes and their associated factors over time, so that strategies can be applied to address unmet needs which may perpetuate the occurrence of behaviours of concern. Responding to behaviour changes in a Person-Centred way can help to alleviate the burden of care and improve the quality of life of the person living with dementia and their caregivers.

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]]> Integrating Play into Dementia Treatment Plans https://www.dementiahub.sg/dementia-practice/integrating-play-into-dementia-treatment-plans/ Tue, 27 Feb 2024 03:19:29 +0000 https://www.dementiahub.sg/?post_type=dementia&p=46250 Play activities have many benefits for persons living with dementia and can be incorporated into non-pharmacological interventions. This article provides an overview of the benefits, types of activities, and strategies for incorporating play into dementia stage care settings.

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Dementia, a progressive neurological disorder affecting millions globally, prompts a multidimensional approach to care. While pharmaceutical interventions are prevalent, the recognition of non-pharmacological strategies is on the rise. Play, seemingly incongruous with dementia, can also be incorporated into non-pharmacological treatments for dementia.  

This article provides an overview of the benefits, types of activities, and strategies for incorporating play into dementia stage care settings.

Play as part of Non-Pharmacological Interventions in Dementia Care

Non-pharmacological interventions play a pivotal role in dementia care. These interventions encompass psychological, behavioral, and social techniques, enhancing overall care and optimizing cognitive and emotional functioning. These interventions generally focus on 6 functional domains1:

  • Auditory music and rhythm
  • Visuospatial and fine motor skills
  • Language and verbal skills
  • Executive functions
  • Kinaesthetic and gross motor skills
  • Social functioning
  •  

Examples of non-pharmacological interventions which incorporate elements of play include:

Benefits of Play in Dementia Treatment

Engaging in play stimulates multiple brain areas2, which over time can promote cognitive flexibility and problem-solving skills. It evokes positive emotions, boosts self-esteem, and improves social interaction. As early as a decade ago, play has been used as part of dementia treatments and has shown positive results for attention, concentration, memory and orientation3. A formal review of 15 such play interventions also pointed to greater emotional stability, cognitive functioning and general quality of life for persons living with dementia4.

Play can also serve as a therapeutic outlet for managing behavioral symptoms like agitation. It redirects focus, alleviates restlessness and reduces anxiety. Physical play activities, such as gentle aerobic exercises or dance movements, contribute to improved mobility, balance, and overall well-being.

In addition to these benefits, play enhances the quality of life by providing moments of joy, laughter, and connection. It creates opportunities for social engagement, fostering a sense of belonging and community.

Types of Play Activities for Persons Living with Dementia

Sensory Stimulation Activities

  • Using different scents, tactile experiences, and familiar mus.ic for multisensory engagement.
  • Using scents the individual associates with positive memories and different textures for enhanced stimulation.

Creative Expression through Arts and Crafts

  • Crafting activities for self-expression and emotional well-being.
  • Painting, sculpting, and creating collages for individuality and personal expression.
  • Different types of art like nagomi

Simple Games and Puzzles

  • Word puzzles, spatial reasoning games, and adapted board games for cognitive stimulation.
  • Adapting traditional games for accessibility and enjoyment.

Reminiscence and Storytelling Activities

  • Sharing personal stories and looking through photo albums for memory recall.
  • Reading aloud and engaging in group discussions for cognitive stimulation and social connection.

Strategies for Implementing Play in Dementia Care Settings

When integrating play into care settings, we have to consider the stage of dementia progression5 the individual is experiencing. It is best to carefully plan the activities to the needs of the person living with dementia and adjust with ongoing evaluation. Consider the following strategies:
  • Assessing the Person’s Individual Preferences:
    • Conduct thorough assessments to understand preferences, abilities, and dementia stage.
    • Tailor play activities based on assessments for maximum engagement.
  • Training Caregivers and Staff:
    • Provide comprehensive training on incorporating play into daily care routines.
    • Include strategies for adapting activities, being responsive to behaviour changes, and ensuring a safe environment.
  • Adapting Activities Based on stage of Dementia Progression:
    • Regularly assess and adapt play activities to accommodate changing needs.
    • Modify complexity, duration, or format to ensure continued stimulation and enjoyment.

Enhancing Engagement and Wellbeing with Dementia Toys

Specialized toys designed for people whose cognition has been affected by dementia can play a crucial role in enhancing their engagement during therapy sessions and increase their overall well-being. These dementia toys are designed with features that cater to their unique needs and preferences.

Here are some options for toys that you can use during play activities:

Sensory Stimulation Toys
  • Fidget Blankets: These blankets incorporate various textures, fabrics, and attachments, providing tactile stimulation and a soothing sensory experience.
  • Light-Up Sensory Balls: Colorful, soft balls with built-in LED lights that respond to touch, offering visual and tactile stimulation.
Reminiscence and Memory-Enhancing Toys
  • Memory Jogging Puzzles: Customized puzzles featuring familiar images or scenes from the past, promoting memory recall and cognitive stimulation.
  • Life Story Dolls: Personalized dolls with features resembling loved ones, sparking conversations and triggering memories.
Interactive Music and Sound Toys
  • Musical Memory Boxes: Personalized boxes that play familiar tunes or recorded messages, evoking memories and creating a sense of comfort.
  • Interactive Sing-Along Plush Toys: Soft toys that respond to touch by playing familiar songs, encouraging social interaction and enjoyment.
Adapted Games and Activities
  • Large Print Playing Cards: Playing cards with enlarged print for easy visibility, facilitating card games, and enhancing cognitive function.
  • Adapted Board Games: Specially designed board games with simplified rules and larger game pieces, promoting social engagement and enjoyment.
  • Adaptive Sports: Sporting activities modified to enable the active participation of players with differing abilities. These include Floorball and Ten-pin bowling suitable for players using wheelchairs. These activities facilitate a sense of achievement, boost mood and wellbeing
Motor-skill and Exercise Toys
  • Gentle Exercise Bands: Soft resistance bands designed for gentle exercises, promoting mobility, and improving muscle strength.
  • Balloon Volleyball Set: A lightweight set for seated balloon volleyball, encouraging physical activity and hand-eye coordination.

Integrating play into dementia treatment plans offers a myriad of benefits for the person’s overall well-being. By enhancing cognitive, emotional, and social well-being, play provides you with a sense of dignity, engagement, and purpose. Using the person-centered approach, diverse play activities, and caregiver training can transform dementia care settings into enriching environments for the person living with dementia, promoting their holistic well-being.

In conclusion, the integration of play into dementia treatment plans is not just a therapeutic strategy; it is also a profound avenue for enhancing the lives of those navigating the challenges of dementia. The diverse range of non-pharmacological interventions, coupled with the thoughtful inclusion of dementia toys, creates a holistic approach that goes beyond traditional medical models.

Play is a powerful tool in dementia care that has important cognitive, emotional and social benefits. By acknowledging the person’s individuality, tailoring activities to the person’s preferences, and recognizing the importance of play, we can pave the way for moments of joy, connection, and self-expression.

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ABOUT THE CONTRIBUTOR

MARY ANNE ROBERTO

Mary Anne Roberto, co-founder of Always Home Connected, is a CNA (Certified Nursing Assistant) and PAC certified independent consultant. As a specialist in dementia care, she aims to create awareness about those experiencing cognitive changes and to provide caregivers with the necessary resources and tools to alleviate some of the challenges they face on a day-to-day basis.

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References

  1. Wong GHY, Ng CKM, Lai CKY, et al. Development of six arts, a culturally appropriate multimodal nonpharmacological intervention in Dementia. Gerontologist. 2014;55(5):865-874. DOI:10.1093/geront/gnu102.
  2. Alzheimer’s Society London (n.d.). Brain training and dementia. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/additional-treatments-for-dementia-risk/brain-training
  3. ETH Zurich (2021, April 9). Fighting Dementia With Play. Neuroscience News. https://neurosciencenews.com/dementia-play-therapy-18205/
  4. Li, B., Luo, Y. and Lin, M. (2021), A systematic review of the use of play in dementia care. Alzheimer’s Dement., 17: e057509. https://doi.org/10.1002/alz.057509
  5. Roberto, M. A. (2023, October 6). Importance of Understanding the Dementia Stages. Always Home Connected. Retrieved December 20, 2023, from https://alwayshomeconnected.com/blogs/news/dementia-stages

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]]> Communication Approaches in Dementia Care https://www.dementiahub.sg/dementia-practice/communication-approaches-in-dementia-care/ Fri, 07 Jul 2023 02:48:01 +0000 https://www.dementiahub.sg/?post_type=dementia&p=28039 Reality orientation, validation and reminiscence are effective methods to facilitate communication with persons living with dementia. Find out how you can use these approaches to help people living with dementia.

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Several psychosocial approaches have been deemed to be effective in facilitating communication, providing a sense of security, and improving the well-being of persons living with dementia. These approaches include:

  • Reality Orientation
  • Validation
  • Reminiscence

 

Read on to gain a deeper understanding of what these approaches are, their respective benefits, and how best to carry them out in your interactions with persons living with dementia.

Reality Orientation, Validation & Reminiscence Approaches

Reality Orientation

What is it?

Reality orientation was first developed in the 1960s as a technique to improve the quality of life of persons living with dementia, although its origins were to rehabilitate veterans who were significantly affected by the war.  
 
Reality orientation provides them with conversational clues about who and where they are, the day of the week and the time of the day, current events, the weather, and other “orienting” information. It is best suited for use with persons in the early stage of dementia, where memory loss has not yet progressed. 

Benefits

Over time, persons living  with dementia may withdraw from contact with others and the environment as they become increasingly disoriented. This results in a lack of sensory stimulation. Reality orientation was found to be effective in providing persons living with dementia with a greater understanding of their environment, possibly resulting in an improved sense of control or self-esteem.

How is it carried out?

Reality orientation operates through the presentation of orientation information (for example time, place and related persons). People are surrounded by familiar objects that can be used to stimulate their memory and provide them with a greater understanding of their surroundings.

It is important to complement words with pictorial cues because some people may no longer comprehend written language. Also consider where they are placed — are they at the right height for their field of vision?

Tips

  • Use a clock to display the date and time on a wall at eye level or where it can be easily seen.
  • Place a written copy of the day’s routine in a prominent place where the person living with dementia often goes to, such as the dining area or kitchen.

Source: The Globe and Mail 

Validation

What is it?

Validation Therapy is an approach developed by social worker Naomi Feil who recognised that reality orientation had limited value for persons living with more advanced dementia.

The term “validation” is used in dementia care to describe the technique of affirming the feelings and reality of persons living with dementia, even though it may not correspond with our reality. Dementia often causes memory loss, with recent memories being the most fragile and usually the first to fade. Gradually, memories of events, places and people of the past are perceived as a reflection of their current reality.

For instance, persons living with dementia may believe that they are still young parents concerned about the welfare of their children. In this case, underlying their concern could be feelings of anxiety and worry.

Benefits

Although reasoning and memory are impaired, the emotional responses of persons living with dementia are still intact. Exploring these emotional responses can allow persons living with dementia to explore unresolved feelings and conflicts, as well as release the building up of anxiety and stress that might otherwise further cloud their thoughts. Additionally, by verbalising their memories and thoughts, and by having them validated, they gain a feeling of being accepted.

Other benefits include strengthening the relationship between the care professional and the person living with dementia, building trust, and improving level of cooperation with the person.

How is it carried out?

Responding to the feelings being expressed, as opposed to what is being said or done, is key to this technique. It can help to distract persons living with dementia from an undesired course of action.

Validation is a 3-step approach used in dementia care to communicate an understanding of the emotional state of persons living with dementia.[1]

The steps in validation are:

Step 1: Respectfully acknowledge or validate the feelings the person is experiencing, for example, “You sound upset/worried/angry….”

Step 2: Offer to help the person with his concern by providing emotional support and reassurance, for example, “I would be worried too if I could not find my daughter.”

Step 3: Gently redirect the person’s attention to something more pleasant by reminiscing, changing the topic of conversation or activity, and/or the environment they are in.

Scenario 1 –  Mdm Tan is unable to find her bag. She has forgotten where she has kept it and wrongly accuses her helper of stealing it.

Scenario 2 – Mr Rohan is rummaging through his pockets to find his house keys. He keeps walking towards the front door, trying to leave the centre. He appears worried and says that he wants to go home to be with his family.

Video Resources on Validation Approach  

What is Validation from Naomi Feil
Source: https://vfvalidation.org 

Naomi Feil, the creator of Validation Theory, shares the principles of Validation, its benefits and examines the important qualities of a Validation practitioner. 

TEDxAmsterdam Women
Validation, communication through empathy | Naomi Feil
Source: TEDx Talks

Creator of the Validation Theory and founder of the Validation Training Institute – Naomi Feil, shares the inspiration behind Validation Theory through her early work with the elderly. 

Validation Therapy Technique
Source: Sunrise Senior Living

Eric Portnoff, Director of Memory Support at Sunrise Senior Living, shares a breakthrough in the use of Validation therapy to understand his resident needs through Roberta’s story. 

Reminiscence

What is it?

Reminiscence is a method in dementia care that focuses on facilitating recollection of past events and experiences with persons living with dementia.

Persons living with dementia often feel more at home in the past, particularly as memory loss progresses and their understanding of their current environment diminishes.  Recollection creates opportunities to improve the well-being of persons living with dementia, and for family members and caregivers to meaningfully connect with them.

Benefits

Reminiscing with persons living with dementia creates a space. The priority is to share about them and the feelings they bring, not so much on the accuracy or details.

Reminiscing involves the discussion of past activities, events and experiences with the person living with dementia, sometimes with the aid of tangible prompts such as photographs, household or familiar items from the past, and music or other sound recordings.

Remember that people with dementia may not be able to name the people or places of their earlier life but often have significant feelings associated with them. Knowing something about their past allows us to reminisce with them while assisting with Activities of Daily Living (ADL). This approach may also help us to understand their behaviours.

How is it carried out?

Sometimes memories can be associated with bad experiences.  It is, therefore, important to be aware of this and steer conversations away from them if possible. Ideally, check with their family members for information on good and bad memories that the person may have.

Repetition of stories is common, and care workers should be prepared for this. The positive feelings associated with story telling are what is important, not the story itself.

Reminiscence Therapy
Source: KYDZ International

This videoclip shows ways in which reminiscence therapy is conducted in the dementia ward at St. Andrews Community Hospital. 

Now that you have a better understanding of the workings of these psychosocial approaches, we hope that you feel more prepared to effectively communicate with persons living with dementia and potentially alleviate any feelings of distress or discomfort in your clients. Remember to keep in mind the specific needs of your clients before deciding on which approach to use. 

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Additional Resources

Gladys Wilson and Naomi Feil – Validation
Source: memorybridge

Naomi Feil demonstrates the application of Validation Theory through her interaction with Galdys Wilson. 

Naomi Feil - The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's and Other Dementias

The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer’s and Other Dementias
by Naomi Feil

This resource comprises a total of 15 compelling case studies aimed at helping healthcare professionals build relationships with persons living with dementia at various stages, understand and handle various behaviours of concern, better communicate with persons living with dementia, and utilise the Validation approach in various care settings.  

More Info
Reminiscence

Reminiscence: Social and Creative Activities with Older People in Care (Speechmark Editions)
by Roger Sim

This resource highlights the principles behind reminiscence work and includes ideas for activities, themes and resources using photographs, slides, videos, cultural trips, amongst others.

More Info
Reminiscence and Recall

Reminiscence and Recall: A Guide to Good Practice
by Faith Gibson

This resource contains everything that anyone, especially healthcare professionals in various care settings, might want to know about reminiscence work. The introduction clearly states a philosophy which makes the case for reminiscence work while indicating what aspects of good practice should underpin it as an activity. 

More Info

Read Next

References

[1]Feil, N (2012) The Validation Breakthrough. Health Professions Press: Baltimore

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]]> Why Do Behavioural Changes Happen? https://www.dementiahub.sg/living-well-with-dementia/why-do-behavioural-changes-happen/ Tue, 25 Oct 2022 10:04:41 +0000 https://www.dementiahub.sg/?post_type=dementia&p=15508 Dementia is accompanied by behavioural changes, which affect your loved one living with dementia and all of you around him/her. Behavioural changes can be one of the aspects of dementia that are most difficult to address. Persons living with dementia who experience behavioural changes are often described as having a “completely different personality” from their “old self”.

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Dementia is accompanied by behavioural changes, which affect your loved one living with dementia and all of you around him/her. Behavioural changes can be one of the aspects of dementia that are most difficult to address. Persons living with dementia who experience behavioural changes are often described as having a “completely different personality” from their “old self”. Different behaviour changes occur at different points in mild and moderate stages of dementia, and vary between people and across different types of dementia.

These are some common behaviours exhibited by persons in the mild, moderate, and advanced stages of dementia that vary from person to person:

Mild Dementia

⇒ Forgetting things

⇒ Occasionally repeating themselves

⇒ Isolating themselves from others

⇒ Feeling tired all the time

⇒ Being easily irritated

Moderate Dementia

⇒ Getting lost in familiar places

⇒ Repeating things said

⇒ Problems with communication

⇒ Neglecting personal hygiene and self-care

⇒ Losing track of time & events

⇒ Misplacing items more frequently

⇒ Behavioural disturbances

⇒ Forgetting the names of common objects and familiar people

⇒ Forgetting important events, e.g. birthdays of their children

⇒ Being confused about timings and places

⇒ Poor or decreased judgement

⇒ Problems with abstract thinking

⇒ Swallowing problems

Advanced Dementia

⇒ Losing mobility and ability to perform daily tasks

⇒ Losing ability to communicate

⇒ Food refusal

⇒ Swallowing problems

Sometimes, behavioural changes during mild and moderate stages of dementia can cause concern. Some examples of behaviours of concern that are commonly seen include:

Aggression

Agitation

Being easily upset

Being easily irritable

Being prone to argue

Inappropriate screaming or crying

Refusal to shower or be groomed

Running away from home

Disinhibition

Sexually inappropriate behaviour

Socially inappropriate behaviour

Hoarding

Irregular Night-time Activity (Sundowning)

Getting up at night

Repetitive Behaviours

Sundowning

Anxiety or excessive worry

Apathy or indifference

Delusions and/or hallucinations

Depression

Misidentifying familiar people

Personal Stories

What My Grandmother Was Trying To Say

In this video, Dr. Chen Shiling, who cared for her late grandmother living with dementia, tells us how she has learnt to understand what her grandmother was trying to communicate through many trying episodes and her grandmother’s behavioural changes, which included her making wrongful accusations, wandering behaviour, and depression.

Dr. Chen Shiling is a Resident Physician at Khoo Teck Puat hospital. She was raised by her grandmother who had dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Where Is My Money?

Episodes involving accusations, arguments, and tension are trying and stressful for family members. Unfortunately, these situations are common in households with persons living with dementia. In this video, Lily tells us her secret to always being able to ‘find’ missing money that has been misplaced by her mother-in-law.

Lily Phang is a caregiver and co-founder of Homage, a caregiving service. She helps her family to cope with the symptoms and behavioural changes that her mother-in-law, Tan Mui Hua faces.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Causes of Behaviour Changes

Every individual has needs that need to be met. However, as dementia affects the brain which controls all mental functions and voluntary behaviours including thoughts, emotions, and speech, the progression of dementia may cause your loved one to be increasingly less able to recognise their needs, know how to meet them, or communicate them. In addition to this, behaviour changes also occur due to changes in the brain. The type of behaviour change exhibited depends on the areas of the brain affected by the condition causing the person’s dementia as well.

It is also crucial to understand these behaviours from the perspective of your loved one living with dementia. They may present with these behaviours as a result of their needs not being met, their attempt to meet a need, or an attempt to communicate to individuals around them.

Unmet needs underlying behaviour changes can be generally categorised into the following four factors:

1. Physical Needs: Your loved one living with dementia may be experiencing pain or discomfort, and may be suffering from other illnesses at the same time.

2. Psychological/Cognitive Needs: Your loved one may be depressed or may have other mental health issues. They could also be feeling confused or threatened in an environment that does not seem right or familiar.

3. Social Needs: Your loved one may be feeling lonely, isolated, or bored.

4. Environmental/External Needs: Your loved one may be in an overstimulating environment (e.g., with loud noises or busy environment), or experiencing a different and unfamiliar routine.

Management of Behaviour Changes

When managing your loved one’s behaviours, it is important for you, as a caregiver, to ascertain some factors that may cause certain behaviours to happen. For example:

• What triggers the behaviour: Consider commonly unmet needs, such as constipation, pain, and toileting needs, or environmental triggers such as sounds, smells, and temperature.

• Whether the behaviour is causing distress to the person: If so, prompt treatment may be necessary.

• Whether the safety of the person is compromised: If so, some modifications to the home setting may need to be made to ensure that the environment is safe.

For every behaviour change, it is always good to share the above information you have collected and consult the doctor (geriatrician or psycho-geriatrician) who is seeing your loved one with dementia to rule out any physical health problems (for example, infections, medication side effects) that may be causing it. After ruling these problems out, non-pharmacological approaches should be first attempted to meet your loved one’s unmet needs and minimise or prevent their behaviour changes, before considering pharmacological management.

It is often the daily, non-pharmacological methods and techniques that turn out to be effective in the long-term. Non-pharmacological measures such as psychosocial interventions (e.g., music therapy, art therapy) are usually the first-line approach before medication treatment is considered. Below are some examples of simple, non-pharmacological techniques to consider as well:

1. Revise your approach. The task on hand may be too difficult that it needs to be simplified, or your loved one living with dementia may need some help with it. Help them to focus on their abilities, rather than on their inabilities.

2. Validate your loved one feels. Acknowledge your loved one’s feelings and experience, and patiently communicate this acknowledgement to them by your words and actions. Do not confront or argue – it is not necessary to always correct the person when they are in the wrong.

3. Direct their attention elsewhere. Identify the cause behind the behaviour and address it through engaging your loved one in meaningful activities.

Sometimes, a combination of both non-pharmacological and pharmacological managements may offer better outcomes too. Read further about the Pharmacological Management of dementia and behaviour changes.

Some Tips to Manage Behaviour Changes

In the fifth episode of a 6-part series “All About Dementia – Ask the Experts”, Dr Ng Wai Chong explains why persons living with dementia have changes in their behaviours. He also answers questions related to strategies in managing these behaviour changes, such as wandering behaviour, repetitive behaviour, refusal to take medications, and refusal to eat.

Source: Agency for Integrated Care

The Alzheimer’s Society from the United Kingdom provides general tips to family caregivers on ways to support persons living with dementia to meet their needs and reduce their behaviour changes using a non-pharmacological approach. It also lists a five-step strategy to manage behaviour changes. Read further about Alzheimer’s Society’s tips and strategies. 

Finally, it is not easy managing the behaviour change(s) your loved one living with dementia is exhibiting. It is thus equally important that you take good care of yourself by seeking support from family, friends, counsellors or support groups, in order to better cope with your caregiving journey. Learn more about tips and resources on how to look after yourself.

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]]> Palliative Care https://www.dementiahub.sg/dementia-practice/palliative-care/ Sat, 08 Oct 2022 09:25:39 +0000 https://www.dementiahub.sg/?post_type=dementia&p=8054 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.

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

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]]> How Effective are Dementia Medications https://www.dementiahub.sg/dementia-practice/how-effective-are-dementia-medications/ Sat, 08 Oct 2022 09:04:29 +0000 https://www.dementiahub.sg/?post_type=dementia&p=8009 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.

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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.

Common Medications Prescribed for Dementia

Pharmacological management of dementia should be used within a multidisciplinary biopsychosocial approach, where medical issues, behavioural and psychological symptoms, as well as the general wellbeing of the person living with dementia and caregiver, are being considered.

Acetylcholinesterase Inhibitors

Uses:

  • Symptomatic management for cognition and global functioning
  • Used primarily to treat mild to moderate stages of the disease although there is also evidence of effectiveness in advanced dementia

Types of drugs:

  • Donepezil (Aricept)
  • Rivastigmine (Exelon*)
  • Galantamine (Reminyl)

Note: Exelon is available in a patch form to be stuck onto the skin.

N-methyl D-aspartate (NMDA) antagonists (which prevent cell damage from glutamate), such as Memantine

Uses:

  • Used to treat moderate to advanced stages of the disease
  • Little evidence supports its benefit in mild dementia
  • Can be used on its own or in combination with AChEIs

Types of drugs:

  • Memantine

Antipsychotics, Antidepressants, Mood Stabilisers and Sedatives

Uses:

  • Used to treat various behaviour changes associated with dementia, such as anxiety, depression, aggression, agitation and sleep problems

Types of drugs:

  • Typical: Haloperidol
  • Atypical: Quetiapine, Risperidone, Olanzapine, etc.

The following sections provide more detailed information on each type of medication.

Acetylcholinesterase inhibitors (AChEIs)

AChEIs remain as one of the key medications for symptomatic management in persons living with dementia. To date, there is limited evidence supporting AChEIs of having effect in neuroprotection or alteration of the disease trajectory.

What It Is Used For

AChEIs has been shown to improve activities of daily living (ADLs), cognitive and neuropsychiatric symptoms in mild to moderate dementia1, as well as in severe Alzheimer’s disease.2

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 Drugs7-10

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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Read Next

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 https://www.dementiahub.sg/dementia-practice/person-centred-care-planning-in-dementia/ Sat, 08 Oct 2022 08:18:40 +0000 https://www.dementiahub.sg/?post_type=dementia&p=7892 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.

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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.

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:

  1. Upon admission, preliminary assessments and care plans should be administered and developed, respectively;
  2. Clients’/residents’ assessments, care needs, goals of care, interventions, outcomes, and evaluation of care should be documented;
  3. Ongoing comprehensive assessments are necessary; and
  4. 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.):

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:

  1. Environment
  2. Language and communication
  3. Care Plans
  4. Activities
  5. Problem solving processes for working with behavioural communication
  6. Communication and leadership
  7. Team structure and roles
  8. Staff knowledge and training
  9. 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
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  2. 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
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  8. Kitwood, T. (1997). Dementia reconsidered: The person comes first. Buckingham: Open University Press.
  9. 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
  10. 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
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  13. Care Fit for VIPS Partnership. (n.d.). Care Fit for VIPS. https://www.carefitforvips.co.uk/
  14. May, H., Edwards, P., & Brooker, D. (2009). Enriched care planning for people with dementia. London and Philadelphia: Jessica Kingsley Publishers.
  15. 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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