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Álvarez-Fernández B, Marín-Carmona JM. [Paradoxical lucidity and personal identity in patients with advanced dementia: change of paradigm?]. Rev Esp Geriatr Gerontol 2024; 59:101493. [PMID: 38691896 DOI: 10.1016/j.regg.2024.101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 05/03/2024]
Abstract
In this article we approach the concept of paradoxical lucidity (LP) (an unexpected, spontaneous, significant and relevant episode of communication or connection) in persons with advanced dementia. The existence of LP could change the paradigm of dementia as a degenerative, chronic, progressive and irreversible disease (where neuronal death plays the leading role), towards a model where functional deficits of neuronal networks acquire importance, which raises new potentially reversible therapeutic and rehabilitative possibilities. We analyze the ethical consequences that these episodes may have with respect to the implicated persons (patients, caregivers and professionals in charge of their care) and try to answer the following question: Do persons with advanced dementia continue to maintain their personal identity despite suffering cognitive impairment so severe?. The LP indicates that this is possible. In this work we make a transversal outline of the different concepts and theories of personal identity in these patients, from different areas of knowledge (philosophy, psychology, neuroscience).
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Affiliation(s)
| | - José Manuel Marín-Carmona
- Especialista en Geriatría. Programa de Memoria, Centro de Envejecimiento Saludable, Ayto, Málaga, España.
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Griffin JM, Kim K, Finnie DM, Lapid MI, Gaugler JE, Batthyány A, Bangerter LR, Biggar VS, Frangiosa T. Developing and describing a typology of lucid episodes among people with Alzheimer's disease and related dementias. Alzheimers Dement 2024; 20:2434-2443. [PMID: 38305566 PMCID: PMC11032560 DOI: 10.1002/alz.13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION This study examined lucid episodes among people living with late-stage Alzheimer's disease and related dementias (PLWD) and then developed a typology of these episodes to help characterize them. METHODS Family caregivers of PLWD provided information about witnessed episodes, including proximity to death, cognitive status, duration, communication quality, and circumstances prior to lucid episodes on up to two episodes (caregiver N = 151; episode N = 279). Latent class analysis was used to classify and characterize empirically distinct clusters of lucid episodes. RESULTS Four lucid episode types were identified. The most common type occurred during visits with family and among PLWD who lived > 6 months after the episode. The least common type coincided with family visits and occurred within 7 days of the PLWD's death. DISCUSSION Findings suggest that multiple types of lucid episodes exist; not all signal impending death; and some, but not all, are precipitated by external stimuli.
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Affiliation(s)
- Joan M. Griffin
- Division of Health Care Delivery Research and Kern Center for the Science of Healthcare DeliveryMayo ClinicRochesterMinnesotaUSA
- Kern Center for the Science of Healthcare DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Kyungmin Kim
- Department of Child Development and Family StudiesResearch Institute of Human EcologySeoul National UniversitySeoulRepublic of Korea
| | - Dawn M. Finnie
- Kern Center for the Science of Healthcare DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Maria I. Lapid
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Joseph E. Gaugler
- School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Alexander Batthyány
- Viktor Frankl Research Institute for Theoretical Psychology and Personalist StudiesPázmány Péter Catholic UniversityBudapestHungary
| | - Lauren R. Bangerter
- Health Economics and Aging Research InstituteMedStar Health Research InstituteHyattsvilleMarylandUSA
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Roehrs P, Fenwick P, Greyson B, Kellehear A, Kothe K, Nahm M, Roe C, Tassell-Matamua N, Woollacott M. Terminal Lucidity in a Pediatric Oncology Clinic. J Nerv Ment Dis 2024; 212:57-60. [PMID: 37734159 DOI: 10.1097/nmd.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals. Unanticipated and unexplained changes in mental clarity, verbal communication, and/or physical capability in the days and hours before the death of the pediatric patients were observed. Each patient's medical condition should not have allowed for such changes. The phenomenon known as terminal lucidity provides a conceptual framework for these deviations, although more systematic documentation and clinical research is required before definitive conclusions can be drawn.
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Affiliation(s)
| | | | | | | | | | - Michael Nahm
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Chris Roe
- University of Northampton, Northampton, United Kingdom
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Ross JP, Post SG, Scheinfeld L. Lucidity in the Deeply Forgetful: A Scoping Review. J Alzheimers Dis 2024; 98:3-11. [PMID: 38339937 DOI: 10.3233/jad-231396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background Even in severe states of Alzheimer's disease and related dementias (ADRD), accounts of an unexpected or paradoxical return of awareness and lucidity have been reported in some patients, documented formally, and studied. Objective A scoping review was undertaken to survey the literature on the topic. Methods Five databases were searched using pertinent search terms. Results were deduplicated and subsequently screened by title and abstract for relevance. Remaining reports were read and included or excluded using specific inclusion criteria. 30 results consisted of a mix of perspective papers, case reports, qualitative surveys of caregivers, law journal comments, and mechanistic speculation. Results An equal mix of primary and secondary research was identified. Conclusions The papers collected in this review provide a valuable methodological outline for researching the topic of lucid episodes in ADRD. The verified legitimacy and simultaneous inexplicability of these events promote philosophical discussion, mechanistic investigations, and sorely needed research in the field of ADRD.
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Affiliation(s)
- John Paul Ross
- Department of Family, Population and Preventive Medicine, Center for Medical Humanities, Compassionate Care and Bioethics, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook, NY, USA
| | - Stephen G Post
- Department of Family, Population and Preventive Medicine, Center for Medical Humanities, Compassionate Care and Bioethics, Renaissance School of Medicine at SUNY Stony Brook, Stony Brook, NY, USA
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Benson C, Fehland J, Botsch M, Block L, Gilmore-Bykovskyi A. The Impact of Episodes of Lucidity on People Living With Dementia and Their Caregivers: A Case Report. Alzheimer Dis Assoc Disord 2023; 37:142-144. [PMID: 36988619 PMCID: PMC10238644 DOI: 10.1097/wad.0000000000000553] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
People living with dementia (PLWD) may experience the episodes of lucidity (ELs), defined as a sudden return of abilities presumed to have been lost and presenting as meaningful communication and connection. Early research on ELs in advanced disease stages suggests these are predominantly positive events. This case report draws from 1 outlier case from a descriptive qualitative study on caregivers of PLWDs' experiences with ELs. The caregiver-reported events perceived as an EL being accompanied with unexpected self-awareness, leading to a negative emotional reaction and feelings of loss. This case report contributes insights to the current understandings of ELs as exclusively relevant in advanced stages of dementia, as similar events may present in earlier disease stages, and may be associated with the negative emotional experiences among PLWD. Future research is needed to consider the ethical implications surrounding ELs and to support the caregivers in anticipating and responding to ELs.
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Affiliation(s)
| | | | | | - Laura Block
- BerbeeWalsh Department of Emergency Medicine
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine
- Center for Health Disparities Research, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI
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Gilmore-Bykovskyi A, Block L, Benson C, Fehland J, Botsch M, Mueller KD, Werner N, Shah MJ. "It's You": Caregiver and Clinician Perspectives on Lucidity in People Living With Dementia. THE GERONTOLOGIST 2023; 63:13-27. [PMID: 35797987 PMCID: PMC10091484 DOI: 10.1093/geront/gnac095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Episodes of lucidity (ELs), or a transient return of abilities believed to be lost in people living with dementia, are a growing area of interest. These events hold important implications for care, caregiving, and our understanding of underlying etiologies. Research on ELs is largely limited to retrospective reports. The perspectives of professional and family caregivers on ELs and research approaches can inform efforts to define and study lucidity. The present study examined family caregiver and hospice clinician experiences with and perspectives on ELs in people living with dementia and observational approaches to studying these events. RESEARCH DESIGN AND METHODS This exploratory, descriptive qualitative study employed semistructured interviews (N = 20 caregivers, N = 6 clinicians). Data were analyzed using Rapid Identification of Themes and subsequent duplicate review of interview data to enhance trustworthiness. RESULTS Most participants readily recalled events they perceived as ELs, describing a transient return of abilities they felt was significant and/or meaningful. Defining features, interpretations, and the perceived impact of ELs varied, although ELs were commonly conceptualized as a manifestation of self. Caregivers described extensive efforts to detect patterns and supportive social conditions for ELs. Participants supported use of audiovisual observation to study ELs and provided recommendations for privacy, workflow, and caregiver engagement. DISCUSSION AND IMPLICATIONS Interpretations of ELs are heterogeneous, and recognition of these events may necessitate close familiarity with the person living with dementia. Participants endorse observational approaches and integration of caregivers in this research.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA.,Center for Health Disparities Research, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Laura Block
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Clark Benson
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Jess Fehland
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Meghan Botsch
- BerbeeWalsh, Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Kimberly D Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mindy J Shah
- Department of Medicine Division of Geriatrics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
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Teresi JA, Ramirez M, Ellis J, Tan A, Capezuti E, Silver S, Boratgis G, Eimicke JP, Gonzalez-Lopez P, Devanand DP, Luchsinger JA. Reports About Paradoxical Lucidity from Health Care Professionals: A Pilot Study. J Gerontol Nurs 2023; 49:18-26. [PMID: 36594915 PMCID: PMC11100277 DOI: 10.3928/00989134-20221206-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although clinicians caring for persons at the end of life recognize the phenomenon of paradoxical/terminal lucidity, systematic evidence is scant. The current pilot study aimed to develop a structured interview instrument for health care professionals to report lucidity. A questionnaire measuring lucidity length, degree, content, coinciding circumstances, and time from episode to death was expanded to include time of day, expressive and receptive communication, and speech during the month prior to and during the event. Thirty-three interviews were conducted; 73% of participants reported ever witnessing paradoxical lucidity. Among 29 events reported, 31% lasted several days, 20.7% lasted 1 day, and 24.1% lasted <1 day. In 78.6% of events, the person engaged in unexpected activity; 22.2% died within 3 days, and 14.8% died within 3 months of the event. The phenomenological complexity of lucidity presents challenges to eliciting reports in a systematic fashion; however, staff respondents were able to report lucidity events and detailed descriptions of person-specific characteristics. [Journal of Gerontological Nursing, 49(1), 18-26.].
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Affiliation(s)
- Jeanne A. Teresi
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
- Columbia University Stroud Center at New York State Psychiatric Institute
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - Julie Ellis
- Nursing and Midwifery Department, La Trobe University
| | - Amil Tan
- Graduate Center, City University of New York
- School of Nursing, Hunter College
| | | | - Stephanie Silver
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Gabriel Boratgis
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Joseph P. Eimicke
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
| | - Paloma Gonzalez-Lopez
- Research Division, Hebrew Home at Riverdale by RiverSpring Living, Riverdale, New York, USA
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Schweda M, Jongsma K. Death in Advance? A critique of the "Zombification" of people with dementia. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:37. [PMID: 35972614 PMCID: PMC9380668 DOI: 10.1007/s40656-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
This contribution sets out to criticize the prominent metaphor of "death while alive" in the context of dementia. We first explain the historical origin and development as well as the philosophical premises of the image. We then take a closer look at its implications for understanding dementia and societal attitudes and behaviours towards those affected. In doing so, we adopt a life course perspective that seeks to account for the ethical significance of the temporal extension and structure of human life. According to this perspective, individual existence in time is characterized by normative standards of age-appropriate behavior, evaluative standards of a good life, and teleological notions of successful development which require theoretical analysis and ethical discussion. Such a perspective can contribute significantly to spelling out the implications of the metaphor of death while alive and to criticizing their problematic aspects. Indeed, it makes clear that this metaphor aligns dementia with a different point in the human life course, thus ultimately framing it as a kind of deviation from the biographical norm, a disruption in an assumed temporal order of existence. At the same time, the life course perspective can help to understand why this conception involves ethically problematic distortions and blind spots. The resulting considerations allow conclusions with regard to medical and care ethical debates about self-determination, surrogate decision making, and advance directives in the context of dementia. Furthermore, on a theoretical-conceptual level, they also illustrate the importance of a biography- and culture-sensitive approach to philosophical and ethical reasoning in biomedicine and the life sciences.
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Affiliation(s)
- Mark Schweda
- Division of Medical Ethics, Department of Health Services Research, School for Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Karin Jongsma
- Department of Medical Humanities , UMC Utrecht, Utrecht, The Netherlands
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Psychiatric Illnesses as Disorders of Network Dynamics. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:865-876. [DOI: 10.1016/j.bpsc.2020.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 01/05/2023]
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10
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Boniolo G. Demented patients and the quandaries of identity: setting the problem, advancing a proposal. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:21. [PMID: 33587205 PMCID: PMC7884352 DOI: 10.1007/s40656-021-00365-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/01/2021] [Indexed: 05/19/2023]
Abstract
In the paper, after clarifying terms such as 'identity', 'self' and 'personhood', I propose an empirical account of identity based on the notion of "whole phenotype". This move allows one to claim the persistence of the individuals before and after their being affected by dementia. Furthermore, I show how this account permits us to address significant questions related to demented individuals' loss of the capacity of moral decisions.
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Affiliation(s)
- Giovanni Boniolo
- Dipartimento di Neuroscienze e Riabilitazione, University of Ferrara, Ferrara, Italy.
- Civitas Vitae Research Centre at Fondazione OIC onlus, Padova, Italy.
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Morris P, Bulman D. Lucidity in the Context of Advanced Neurodegenerative Disorders: A Concept Analysis. J Gerontol Nurs 2020; 46:42-50. [DOI: 10.3928/00989134-20201106-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
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12
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Understanding the self of people with dementia : Psychological and philosophical considerations. Z Gerontol Geriatr 2020; 54:161-166. [PMID: 32206874 PMCID: PMC7946685 DOI: 10.1007/s00391-020-01718-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Abstract
Background The ability to create and maintain an ongoing life narrative is a key characteristic of what makes us human; however, people with dementia lose this ability in the course of the disease. If the notion of having a self is intimately linked with being able to create and maintain a life narrative and if people with dementia tend to lose this ability, what kind of self do people with dementia still possess? Objective and methods Recent theories developed in psychology and philosophy suggest that at least two notions of the self have to be distinguished: the experiencing self and the remembering self. This distinction is applied to people with dementia. Results While the remembering self is impaired in people with dementia, their experiencing self remains relatively intact. Critically, the experiencing self is a self with inner depth, mirroring the life history of the individual. Thus, the self of people with dementia is not unextended in time. Although people with dementia may have lost the ability to tell a story about their life, they are still able to express this story in their behavior. Conclusion Understanding the structure of the self of people with dementia can help guide interactions as well as the designing of appropriate interventions and environments. Moreover, realizing the inner depth of the self of people with dementia may help acknowledge their dignity and personhood.
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Maeker É, Maeker B. [Therapeutic relationship and care with the person with severe cognitive impairment]. SOINS. GERONTOLOGIE 2020; 25:42-45. [PMID: 32200990 DOI: 10.1016/j.sger.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The inevitable evolution of cognitive disorders in neurodegenerative diseases, such as Alzheimer's disease, raises questions about the modalities and objectives of care provided to people with these diseases. It justifies the acquisition of a holistic and humanistic perspective to maintain the person as a whole at the core of our priorities. Person-centered care meets this requirement by being rooted in a supportive relationship.
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Affiliation(s)
- Éric Maeker
- Résidence Gisèle-Hernu, 15, rue Georges-Charpak, 62800 Liévin, France.
| | - Bérengère Maeker
- Résidence Gisèle-Hernu, 15, rue Georges-Charpak, 62800 Liévin, France
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Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias. Alzheimers Dement 2019; 15:1107-1114. [DOI: 10.1016/j.jalz.2019.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 01/17/2023]
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15
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Smalheiser NR. Mining Clinical Case Reports to Identify New Lines of Investigation in Alzheimer's Disease: The Curious Case of DNase I. J Alzheimers Dis Rep 2019; 3:71-76. [PMID: 31025031 PMCID: PMC6481472 DOI: 10.3233/adr-190100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mining the case report literature identified an intriguing, yet neglected finding: Deoxyribonuclease I (DNase I) as a possible treatment for Alzheimer’s disease. This finding is speculative, both because it is based on one patient, and because the underlying mechanism(s) of action remain obscure. However, further literature review revealed that there are several plausible mechanisms by which DNase I might affect the course of Alzheimer’s disease. Given that DNase I is an FDA-approved drug, with extensive studies in both animals and man in the context of other diseases, I suggest that investigation of DNAse I in Alzheimer’s disease is worthwhile.
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Affiliation(s)
- Neil R Smalheiser
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
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Sævareid TJL, Lillemoen L, Thoresen L, Førde R, Gjerberg E, Pedersen R. Implementing advance care planning in nursing homes - study protocol of a cluster-randomized clinical trial. BMC Geriatr 2018; 18:180. [PMID: 30103692 PMCID: PMC6090595 DOI: 10.1186/s12877-018-0869-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Close to half of all deaths in Norway occur in nursing homes, which signals a need for good communication on end-of-life care. Advance care planning (ACP) is one means to that end, but in Norwegian nursing homes, ACP is not common. This paper describes the protocol of a project evaluating an ACP-intervention in Norwegian nursing homes. The aims of this research project were to promote the possibility for conversations about the end of life with patients and relatives; promote patient autonomy; create a better foundation for important decisions in the case of medical emergencies and at the end of life; and gain experiences in order to find out what characterizes good ACP and good implementation strategies. METHODS/DESIGN This study was a mixed method study including a cluster-randomized clinical trial. Eight nursing home wards or "clusters" were pair-matched, and one ward from each pair was randomly selected for a 12-month intervention. The intervention consisted of implementing an ACP-guideline. Implementation strategies were training and supervision of project teams and staff in using the guideline, written information to patients and next of kin, and information meetings with nursing home staff. The project was evaluated using both quantitative and qualitative data, and both outcome and process evaluation. Quantitative data included patient chart reviews of ACP, diagnoses, patient preferences for decision-making and treatment, values and wishes that are more general, documented life-prolonging treatment and hospitalizations, and concordance between patient wishes and treatment. The primary outcome was documented ACP. Qualitative data included observations of conversations, interviews with patients, next of kin and health care personnel, logs from project coordinators and conversations, and transcripts from meetings with project teams in the intervention group. DISCUSSION This project attempted to increase the quality and use of ACP in Norwegian nursing homes (NH). A mixed methods approach, inclusion of patients with dementia, attempts to involve, as many patients as possible, and a sustainable implementation plan adapted to real life in nursing homes were strengths of the project.
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Affiliation(s)
| | - Lillian Lillemoen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Lisbeth Thoresen
- Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373 Oslo, Norway
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Elisabeth Gjerberg
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
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Abstract
OBJECTIVE This qualitative study seeks evidence of retained social awareness in individuals with moderate dementia residing in care-homes, when engaged in interactive family visits. METHOD Speech/non-speech data collected from 10/15-minute video-recorded family interactions of five family groups (12 individuals; 2 sessions per family group) were coded using thematic analysis. RESULTS Interactional patterns embedded in familiar bonds provided the context for the superordinate theme: relational social engagement (RSE). This overarched two subthemes: in-step and out-of-step; highlighting that RSE, can occur as a result of both positive and negative familial communication patterns. When familial communication was in-step, despite changed communication pathways, the resident's attempts at social engagement appeared open, relaxed, and responsive. A sense of trust, and familiarity appeared to facilitate reciprocal understanding and the striving of resident family members to retain family group membership. When familial communication was out-of-step, active attempts at reciprocity or open engagement from visiting family members were not observed. At such times, communication became discordant, and frustrated in their efforts to remain an integral part of the family group, the resident appeared disinterested or guarded often retorting with annoyance at visiting family members. CONCLUSION The construct of RSE appears specific to prior meaningful relationships, where optimal social awareness and communication, positive and negative, can occur. Currently, dementia assessment and care does not include RSE during family interactions. Implications are discussed.
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Affiliation(s)
- Bruce Walmsley
- a School of Psychology , University of Newcastle , Callaghan , NSW 2308 , Australia
| | - Lynne McCormack
- b HammondCare , Centre for Positive Ageing , Hammondville , NSW 2170 , Australia
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Ampe S, Sevenants A, Smets T, Declercq A, Van Audenhove C. Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice. PATIENT EDUCATION AND COUNSELING 2017; 100:139-146. [PMID: 27544017 DOI: 10.1016/j.pec.2016.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES (1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. METHODS This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). RESULTS Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. CONCLUSION 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. PRACTICE IMPLICATIONS Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals.
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Affiliation(s)
- Sophie Ampe
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Aline Sevenants
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Tinne Smets
- Vrije Universiteit Brussel, End-of-Life Care Research Group, VUB Campus Jette, Building K, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Anja Declercq
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Chantal Van Audenhove
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I. ‘Bringing respite in the burden of illness’ - dog handlers’ experience of visiting older persons with dementia together with a therapy dog. J Clin Nurs 2016; 25:2223-31. [DOI: 10.1111/jocn.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Swall
- Department of Health Sciences; School of Health and Social Studies; Dalarna University; Falun Sweden
| | - Britt Ebbeskog
- Department of Neurobiology; Caring Science and Social Science; Karolinska Institutet; Huddinge Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning; Informatics; Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Ingegerd Fagerberg
- Ersta Sköndal University College; Department of Health Care Sciences; Stockholm Sweden
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20
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Skaalvik MW, Fjelltun AMS, Normann HK, Norberg A. Expressions of Sense of Self Among Individuals With Alzheimer’s Disease. Res Theory Nurs Pract 2016; 30:161-75. [DOI: 10.1891/1541-6577.30.2.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent research has challenged the previously held view that people with Alzheimer’s disease (AD) lack a sense of self, with several studies demonstrating that the sense of self is partially preserved, even in late stages of AD. The aim of this study was to examine how people with AD express their sense of self (Self 1–3) using the social constructionist theory of selfhood described by Harré (1998). Personal interviews were analyzed deductively. The participants narrated fragments of their life stories and expressed the fear of becoming a burden to family members and of nursing home placement. They expressed Self 1 (personal singularity or personal identity) without any problems, whereas their Self 2 (self-concept) attributes had undergone changes that they had learned to live with. The participants expressed surprisingly few problems with their narratives of Self 3 (social personae), that is, their accounts of interactions with other people. They reported being received positively when they were open about their diagnosis. These results provide further nuances that broaden our understanding of the process of preserving the sense of self, that is, simultaneously being the same and a different person.
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Kuosa K, Elstad I, Normann HK. Continuity and Change in Life Engagement Among People With Dementia. J Holist Nurs 2014; 33:205-27. [PMID: 25549961 DOI: 10.1177/0898010114564684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore the change and continuity in the engagement in life of people with advanced dementia. The idea of meaningful activities is commonly used in nursing research, but few studies have been performed on what makes activities meaningful. This study aims to shed light on the meaning of activities in a life course context, changes in activity patterns due to dementia disease, and the significance of narratives told by close relatives. The 11 stories of activities were analyzed using thematic narrative analysis with Leontyev's activity theory as a theoretical framework. The findings revealed several types of changes: slow and abrupt changes in everyday and physical activities, changes in the person's level of awareness, and changes in habits in new care settings and environments. The meaningfulness of activities was connected to a person's background, his/her motives, lifestyle and identity, and the contextuality of activities. Through the narratives, nursing care personnel could acquire a nuanced picture of the person and his/her engagement in life. These narratives are vital to helping people who have dementia to keep up with meaningful activities and enhance their quality of life, especially when the person has deficiencies in communication.
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Affiliation(s)
- Kirsti Kuosa
- UiT The Arctic University of Norway, Tromso, Norway
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22
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Mitoku K, Shimanouchi S. The decision-making and communication capacities of older adults with dementia: a population-based study. Open Nurs J 2014; 8:17-24. [PMID: 25002912 PMCID: PMC4083186 DOI: 10.2174/1874434620140512001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 11/22/2022] Open
Abstract
The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being "always capable"; 41.3% were reported as being "sometimes capable"). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being "always capable"; 15.4% were reported as being "sometimes capable"). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.
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Affiliation(s)
- Kazuko Mitoku
- Department of Nursing, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Setsu Shimanouchi
- Faculty of Nursing, Hiroshima Bunkagakuen, Kure-city, Hiroshima, Japan
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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I. Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer′s disease? Int J Older People Nurs 2014; 10:84-93. [DOI: 10.1111/opn.12053] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Swall
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Britt Ebbeskog
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning, Informatics, Management and Ethics; Cancer and Palliative care; Karolinska Institutet; Stockholm Sweden
| | - Ingegerd Fagerberg
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
- Department of Health Care Science; Ersta Sköndal University College; Stockholm Sweden
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Abstract
The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of 'Assigning time', 'Establishing security and trust' and 'Communicating equality' were strategies for arriving at the core category, 'Opening up', which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregiver's overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.
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Hedman R, Hansebo G, Ternestedt BM, Hellström I, Norberg A. How people with Alzheimer's disease express their sense of self: analysis using Rom Harré's theory of selfhood. DEMENTIA 2012; 12:713-33. [PMID: 24337636 DOI: 10.1177/1471301212444053] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to use Harré's social constructionist theory of selfhood to describe how people with mild and moderate Alzheimer's disease (AD) express their sense of self. The findings show that Self 1, the embodied sense of being a person, was expressed fluently by participants through the use of first-person indexicals. Self 2, the experienced personal attributes and life narrative, had undergone changes. Those changes were not entirely for the worse; participants had also developed new skills in managing life with AD. In a lifetime perspective, those changes were minor and participants perceived themselves to be basically the same people that they were before having AD. When constructing Self 3, the social personae, participants usually described being supported by others, but sometimes described being exposed to malignant positioning. They also feared that they might become more exposed to negative attitudes as their AD progressed. However, participants were understanding towards the offensive behaviours of others.
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Affiliation(s)
- Ragnhild Hedman
- Ersta Sköndal University College, Sweden; Karolinska Institutet, Sweden
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26
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Mark RE. Understanding the individual with Alzheimer’s disease: Can socioemotional selectivity theory guide us? ACTA ACUST UNITED AC 2012. [DOI: 10.4236/aad.2012.13010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Enmarker I, Olsen R, Hellzen O. Management of person with dementia with aggressive and violent behaviour: a systematic literature review. Int J Older People Nurs 2011; 6:153-62. [PMID: 21539720 DOI: 10.1111/j.1748-3743.2010.00235.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Studies indicate that physical and pharmacological restraints are still often in the frontline of aggression management in a large number of nursing homes. In the present literature review the aim was to describe, from a nursing perspective, aggressive and violent behaviour in people with dementia living in nursing home units and to find alternative approaches to the management of dementia related aggression as a substitute to physical and chemical restraints. METHODS A systematic literature review in three phases, including a content analysis of 21 articles published between 1999 and August 2009 has been conducted. RESULTS The results could be summarised in two themes: 'origins that may trigger violence' and 'activities that decrease the amount of violent behaviour'. Together, the themes showed that violence was a phenomenon that could be described as being connected to a premorbid personality and often related to the residents' personal care. It was found that if the origin of violent actions was the residents' pain, it was possible to minimise it through nursing activities. This review also indicated that an organisation in special care units for residents who exhibit aggressive and violent behaviour led to the lesser use of mechanical restraints, but also an increased use of non-mechanical techniques. CONCLUSION The optimal management of aggressive and violent actions from residents with dementia living in nursing homes was a person-centred approach to the resident. Qualitative studies focusing on violence were sparsely found, and this underlines the importance of further research in this area to elucidate how violence and aggressiveness is experienced and understood by both staff and patients. RELEVANCE TO CLINICAL PRACTICE To communicate with people with dementia provides a challenge for nurses and other health caregivers. To satisfy the needs of good nursing care, an important aspect is therefore to get knowledge and understanding about aggressive and violent behaviour and its management.
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Affiliation(s)
- Ingela Enmarker
- Faculty of Health Science, Nord-Trondelag University College, Namsos, Norway.
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29
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Ericsson I, Hellström I, Kjellström S. Sliding interactions: An ethnography about how persons with dementia interact in housing with care for the elderly. DEMENTIA 2011. [DOI: 10.1177/1471301211409376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This ethnography describes how persons with dementia interact with cognitively intact persons in housing with care for the elderly. The results, drawing upon 31 observation sessions and nine interviews, are described under the following themes, which were interpreted from the standpoint of social interaction theory: interaction with expression of satisfaction, disorientation, and dissociation. Interaction provided satisfaction, but did not always reflect a positive experience. Awareness in persons with dementia seemed to be greater than others perceived and, as a result, interaction was adversely affected by frequent well-intentioned corrections and comments. Participation in interaction can be encouraged and feelings of indignation avoided by assuming that persons with dementia are aware of their situation and how others behave toward them. Sensitivity is required to interpret individuals' expressions of desire not to participate, while simultaneously it is important to try to interpret why they want to refrain.
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30
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Hammar LM, Emami A, Engström G, Götell E. Communicating through caregiver singing during morning care situations in dementia care. Scand J Caring Sci 2011; 25:160-8. [DOI: 10.1111/j.1471-6712.2010.00806.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hammar LM, Emami A, Engström G, Götell E. Reactions of persons with dementia to caregivers singing in morning care situations. Open Nurs J 2010; 4:35-41. [PMID: 21249163 PMCID: PMC3023064 DOI: 10.2174/1874434601004010035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 08/17/2010] [Accepted: 09/24/2010] [Indexed: 11/22/2022] Open
Abstract
’Music therapeutic caregiving’, when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with’Music therapeutic caregiving’. Through a qualitative content analysis two themes emerged.’Being in a different reality’ was based on’usual’ morning care situations. The caregivers’ experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,’Being present’, was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that’Music therapeutic caregiving’ might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving.
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Affiliation(s)
- Lena Marmstål Hammar
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Sweden
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32
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Abstract
OBJECTIVE Although awareness has been extensively researched in relation to people with dementia, studies have focussed mainly on people who have dementia of mild to moderate severity. Consequently, relatively little is known about awareness in people with severe dementia, and there is no clear conceptual framework to indicate how this should be understood or investigated. METHOD This review presents a conceptual framework for considering awareness in people with moderate to severe dementia which distinguishes fundamental awareness of sensory and perceptual stimuli and three levels of awareness involving more complex cognitive operations, termed 'on-line monitoring', 'evaluative judgement' and 'meta-representation', and provides an integration of the available evidence regarding each level. RESULTS Findings indicate that sensory and perceptual awareness can be detected even in people with very severe or end-stage dementia, while some aspects of complex awareness may be retained into the severe stages. CONCLUSIONS The environmental context and the nature of caregiving interactions influence the extent to which awareness is expressed. There may be scope for enhancing the expression of some aspects of awareness in people with moderate to severe dementia, but this should only be undertaken where it is likely to improve quality of life. Understanding more about awareness is an important element in the provision of high-quality care for people with moderate to severe dementia.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK.
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Ericsson I, Aronsson K, Cedersund E, Hugoson A, Jonsson M, Gerdin EW. The meaning of oral health-related quality of life for elderly persons with dementia. Acta Odontol Scand 2009; 67:212-21. [PMID: 19396715 DOI: 10.1080/00016350902855296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as "oral health-related QoL". People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia. MATERIAL AND METHODS Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference. RESULT Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia. CONCLUSION The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.
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Byrne EJ, Benoit M, Lopez Arrieta JM, Geraldi C, Koopmans R, Rolland Y, Sartorius N, Stoppe G, Robert P. For whom and for what the definition of severe dementia is useful: an EDCON consensus. J Nutr Health Aging 2008; 12:714-9. [PMID: 19043646 DOI: 10.1007/bf03028619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The European Dementia Consensus Network (EDCON) is a special project of the Madariaga Foundation located in Brussels. The Madariaga Foundation seeks to facilitate collaboration between European countries and between the public and private sector. This paper will review the differences in the definitions of Severe Dementia and summarise the EDCON consensus on their implications for management. EDCON recommends that:--The attributes of the person suffering from dementia should be given as much attention (and are as important for care) as the severity of cognitive decline in dementia;--The dementia syndrome (particularly in it's severe form) is inadequately defined by criteria which only includes the domain of cognition;--Physical, legal, social and cultural factors defining the environment of patients and their families should be carefully examined and that the results of this examination should be used in conjunction with the results of the somatic and psychiatric assessment in planning care and placement of the patient;--patients with severe dementia should have access to palliative care; - family members should be included in the care plans for those with severe dementia who are in institutional care.
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Affiliation(s)
- E J Byrne
- Division of Psychiatry, University of Manchester, Education and Research Centre, Wythenshawe Hospital, Manchester, UK
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