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Fundamentals of Dementia Care

Goals for effective dementia care

 

* To ensure that staff provide person-centered dementia care based on thorough knowledge of residents and their abilities and needs.

 

* To help staff and available family act as "care partners" with residents, working with residents to achieve optimal resident functioning and a high quality of life. Note: "Family members" can include people who are related to a resident or are not related but play a significant role in the resident's life.

 

* To have staff use a flexible, problem-solving approach to care designed to prevent problems before they occur by shifting care strategies to meet the changing conditions of people with dementia.

 

What to look for: General dementia care assessment

 

* A holistic assessment of the resident's abilities and background is necessary to provide care and assistance that is tailored to the resident's needs. In completing a holistic, general resident assessment, look for the following aspects of a resident:

 

* Cognitive health

 

* Physical health

 

* Physical functioning

 

* Behavioral status

 

* Sensory capabilities

 

* Decision-making capacity

 

* Communication abilities

 

* Personal background

 

* Cultural preferences

 

* Spiritual needs and preferences

 

Food and Fluid Consumption

Inadequate consumption or inappropriate food and fluid choices can contribute directly to a decline in a resident's health and well-being.

 

Care goals for food and fluid consumption

 

* To have good screening and preventive systems for nutritional care to avoid problems such as weight loss, malnutrition, pressure ulcers, infection, and poor wound healing.

 

* To ensure proper nutrition and hydration so that residents maintain their nutritional health and avoid unnecessary health complications, given resident preferences and life circumstances.

 

* To promote mealtimes as pleasant and enjoyable activities. Mealtime provides an opportunity for staff to observe and interact with residents, helping ensure health, well-being, and quality of life.

 

What to look for: Resident assessment for food and fluid consumption

 

* Ongoing monitoring of residents is necessary to discover changes in food and fluid intake, functional ability, or behaviors during a meal. In addition to the general dementia care assessment, adequate assessment to minimize mealtime difficulties includes observing residents for warning signs such as:

 

* Poor dental health

 

* Difficulty chewing and swallowing

 

* Changes in swallowing ability

 

* Poor utensil use

 

* Refusing substitutions

 

* Low attentiveness to meal

 

* Distractibility

 

* Wandering away during meal

 

* More than 25% of food uneaten

 

Pain Management

Pain is underrecognized and undertreated among people with dementia, primarily because they can have difficulty communicating. Poorly managed pain can result in behavioral symptoms and lead to unnecessary use of psychotropic medications.

 

Care goals for pain management

 

* To ease the distress associated with pain and help a resident enjoy an improved quality of life.

 

* To treat pain as the "fifth vital sign" by routinely assessing and treating it in a formal, systematic way, as one would treat blood pressure, pulse, respiration, and temperature.

 

* To tailor pain management techniques to each resident's needs, circumstances, conditions, and risks.

 

What to look for: Resident assessment for pain management

 

* Pain assessment should occur routinely, including when residents have conditions likely to result in pain and if residents indicate in any manner they may be in pain. In addition to the general dementia care assessment, effective pain assessment addresses the following:

 

* Site of pain

 

* Effect of pain on the person

 

* Pain triggers

 

* Whether pain is acute or chronic

 

* Type of pain

 

* Positive and negative consequences of treatment

 

* For those residents who cannot verbally communicate, direct observation by staff consistently working with them can help identify pain and pain behaviors.

 

Social Engagement and Involvement in Meaningful Activities

Engagement in meaningful activities is one of the critical elements of good dementia care. Activities help residents maintain their functional abilities and can enhance quality of life.

 

Goals for social engagement

 

* To offer many opportunities each day for providing a context with personal meaning, a sense of community choice, and fun.

 

* To design interactions to do with-not to or for-the resident.

 

* To respect resident preferences, even if the resident prefers solitude.

 

What to look for: Assessment for social engagement

 

* A formal initial assessment that involves family, when available, and ongoing interaction with a resident promotes understanding of the activities that would be meaningful to the resident.

 

* In addition to the general dementia care assessment, understanding various resident characteristics will help to best engage them and involve them in meaningful activities. Specifically, determine each resident's

 

* capacity for physical movement

 

* capacity for mental stimulation

 

* interest in social interaction

 

* desire for spiritual participation and fulfillment

 

* cultural values and appreciation

 

* specific recreational interests and preferences