Blog # 11- Utilizing a Person-Centered Approach to Care for Older Adults with Dementia

Articles and Resources:

Fazio, S., Pace, D., Flinner, J., Kallmyer, B. (2017). “The Fundamentals of Person-Centered Care for Individuals with Dementia” The Gerontological Society of America. The Gerontologist. https://watermark.silverchair.com/gnx122.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlowggJWBgkqhkiG9w0BBwagggJHMIICQwIBADCCAjwGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM_P9U8eYm6eeExkknAgEQgIICDb6Q6SBy3wokNwxEQuigY5ikYehaKkBY-0gmF0cK5f1Y_ZJxakUO-OPDjPhxcpIlyPHgZpVksVs4ThTP1anzTZ8i8R2lEI_kKrGG9JDSWnztd3sIuC1XgD_J-V7_MpLIOXmlJJ5N3Ma5sQuYidMajc–L4QLagwyUtCOt139aPDh0spxaUlYlp_eXLRY-Kh6-Q9Ff8uY1pDrhNuyXWaf_GGvFxV6HWHJvwPWxXD90wkSc2cBwLVIPfO7FtChMYERHOeATV-xaNVEGANAqcm9iZdvBwQBpKEkFULti5Rbz0hI7Mv62B7oYOsdzSf2VbLMbOLgSLSzXJ6PIeEGFFz239Tg5mSG1APyWkVbFppxqe_EuhB5EghZGr3ALj49GxRNC5coy9cTFcpbDubV24BjmFZwP5xiTXtUE59bvOL-A0HKGCkZKS26aerYS190q8TUkTsXGeze34mrQSvJFeMpnV6vn4AzPKsSAPOwv465HaYmjZ9tsysdspMYr-on-c432u3o5d_dLmHcSE6LvXBnkmRUTHpv2ntP-fYAGGxK3KoQoKSPc1F5S_T7mptKUUC5ydQElH46TyNfArxXIU7Ipqs64N14oVROVtrJyWjK6YVhF-tYQLpiMnxmwf8tTCYzEgs0fWArOQfqq3-F1yru-t-J0rkPbTMxEyqOpU_i8_yhTuhyo0MQVTasT_jrxQ. Published 19 Jun 2017. doi:10.1093/geront/gnx122

 

“Dementia” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013. Published 19 Apr. 2019.

 

When older adults experience dementia, they are experiencing a multitude of medical (especially neurological) conditions that generally impair memory and cognition. Dementia is generally associated with a neurological condition such as Alzheimer’s Disease, or other associated medical conditions that are immunological; metabolic; or nutritional in nature. As a result of these conditions, dementia can not only affect the health and well-being of an older adult, but dementia can also affect the older adult’s capacity to live independently.

What are some implications that dementia can have in terms of an older adult’s capacity to live independently? Some older adults with dementia may experience malnutrition, which means that they, “eventually reduce or stop eating, affecting their nutrient intake” (Mayo Clinic). Some older adults may be experiencing malnutrition due to causes such as financial hardship which makes it difficult for them to purchase food that will support their health and well-being. Also, if older adults cannot drive where grocery shopping is not a walking distance away, and they do not have a caregiver or a homemaker to purchase food for them, they may also experience malnutrition in this sense as well. Older adults can also experience malnutrition due to issues associated with deglutition (swallowing), or mastication (chewing). If older adults have a condition like pneumonia, in which, “Difficulty swallowing increases the risk of choking or aspirating food into the lungs, which can block breathing” (Mayo Clinic), then older adults can develop malnutrition in this context.

Some older adults with dementia may have symptoms that make it difficult to care for themselves. Unfortunately, some older adults experience the, “Inability to perform self-care tasks” (Mayo Clinic). Older adults, because of their impaired memory and cognition, may have trouble with tasks such as homemaking; personal care; and money management. Also, “As dementia progresses, it can interfere with bathing, dressing, brushing hair or teeth, using the toilet independently, and taking medications accurately” (Mayo Clinic). In addition to older adults not being able to care for themselves, because some older adults experience impaired memory and cognition, some older adults experience challenges associated with their personal safety. One example of a personal safety challenge would be driving. If an older adult has impaired memory and cognition while driving a motor vehicle, an older adult may be at risk at getting into an accident, or even, several accidents which could result in fatalities and injuries among themselves and others. Some older adults with impaired memory and cognition in driving situations would likely experience challenges with visual acuity; depth perception; blind spots; and just being aware of their surroundings for other cars and pedestrians. Cooking is another personal safety challenge as not utilizing kitchen appliances and ingredients in addition to impaired cognition and memory can promote illness; injury; and perhaps food that is not fully cooked (or raw). Older adults who walk alone that have impaired memory and cognition may not remember how to get home, or, to get to where they are supposed to go as they may misinterpret directions and signs or lose sight of directions and signs. Sadly, in some cases of dementia in older adults, “Late-state dementia results in coma and death, often from infection” (Mayo Clinic). Understanding the basics of dementia, and keeping in mind the complications and implications that dementia can have on older adults, how can utilizing a person-centered approach help promote the care of individuals with dementia?

What we need to understand first and foremost is that, “dementia does not universally progress in a linear fashion, and most importantly, it varies from person to person” (Fazio, Pace, Flinner, Kallmyer, 2017). One person may have Alzheimer’s Disease which is a progressive type of dementia which cannot be reversed. As a result, an older adult with this disease will permanently experience symptoms such as memory loss and confusion which generally continue to decline over the course of time. However, another person may be experiencing side effects to a medication which may be promoting dementia-like symptoms. In this case, this kind of dementia could be reversed with the proper treatment. The general idea is that although dementia is a spectrum of associated medical and neurological conditions that can affect memory and cognition, some older adults may have a kind of dementia in which no extensive treatment or care is needed (perhaps occasional check-ins with their primary care doctor), and so they are able to care for themselves with minimal or few formal and informal supports, while other older adults with dementia have it profound to a point where the informal and formal supports are extensive, and are on a 24/7 basis in which they are not able to care for themselves.

Second, “Individuals need comfort or warmth to “remain in one piece” when they may feel as though they are falling apart. Individuals with dementia need to feel attachment when they so often feel as though they are in a strange place. Individuals need to be included and involved both in care and in life, and more than simply being occupied; they need to be involved in past and current interests and sources of fulfillment and satisfaction. Finally, people with dementia need to have an identity and their caregivers must help maintain this identity” (Fazio, Pace, Flinner, Kallmyer, 2017). Older adults with dementia need to know from others, especially caregivers, that they are and always will be people first, and not just people with disabilities. Older adults with dementia need to embrace the help and support of family, friends, and colleagues in times of feeling isolated, and in times of feeling doubt and uncertainty within their own lives. Be mindful of older adults and their past and current hobbies and interests (i.e. sports, music, weather, television, games, food, etc.) that allow themselves, even when experiencing dementia, to find insight into their own identities by taking part of these hobbies and interests in addition to receiving the appropriate treatment and care from their caregivers.

When caregivers are involved with the lives of older adults, they need to recognize that people with dementia are people first, and not just people with dementia. In fact, “personhood can be ensured only within the context of a mutually recognizing, respecting, and trusting relationship” (Fazio, Pace, Flinner, Kallmyer, 2017). When providing care to older adults with dementia, we must also be mindful of ageism and elder speak, both in which negatively influence the false interpretations of how we recognize older adults within our society, especially older adults with dementia. What can be stated is that there are, “processes and interactions that tend to depersonalize a person with dementia, which include disempowerment, labeling, infantilism, and objectification. Words do matter, as language leads to perceptions, and ultimately approaches to care (Fazio, 1996). Labels depersonalize individuals and can lead them to be treated in ways that do not support their personhood” (Fazio, Pace, Flinner, Kallmyer, 2017).

With respect to personhood between older adults with dementia and caregivers, in order to help older adults with dementia to receive the best quality of care in order to have fulfillment in their lives as much as possible, area agencies on aging, elder affair organizations, hospitals, clinics, and other agencies and organizations that work to promote the social work and health management of older adults with dementia need to work on, “developing and regularly reviewing care plans that reflect strengths and needs, allowing use of personal possessions, accommodating individual preferences and daily routines, learning about individual life stories, and offering a variety of activities” (Fazio, Pace, Flinner, Kallmyer, 2017). What this also includes is for professionals and caregivers in the fields of social work and health management to work on, “communicating effectively, experiencing empathy, monitoring the physical environment, assessing physical health, uncovering reasons for behaviors, and being an advocate” (Fazio, Pace, Flinner, Kallmyer, 2017). In the context of the social environment for older adults with dementia, what caregivers and professionals in the social work and health management fields need to work on as well is, “treating individuals with respect, creating an atmosphere of warmth, validating feelings, providing appropriate support and assistance, and fostering a sense of community” (Fazio, Pace, Flinner, Kallmyer, 2017).

In summation, while we do need to know the basics of dementia, and acquire an understanding of the complications and implications that dementia can have on the quality of life on older adults, we do need to assure the best quality of care is provided to older adults with dementia by utilizing a person-centered approach. What this means is that we need to, “1.) Know the person living with dementia; 2.) Recognize and accept the person’s reality; 3.) Identify and support ongoing opportunities for meaningful engagement; 4.) Build and nurture authentic, caring relationships; 5.) Create and maintain a supportive community for individuals, families, and staff; and 6.) Evaluate care practices regularly and make appropriate changes” (Fazio, Pace, Flinner, Kallmyer, 2017).