Dying with Dementia Integrating a Palliative Approach
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Operating The Lodge at Broadm ead and Veterans Health Centr e Dying with Dementia Integrating a Palliative Approach 26 th Conference of Alzheimer’s Disease International Toronto, Ontario March 2011 Janice Robinson, RN, MN, GNC(C) Clinical Nurse Specialist The Lodge at Broadmead, Victoria, BC, Canada Operating The Lodge at Broadmead and Veterans Health Centre
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Dying with Dementia Integrating a Palliative Approach 26 th Conference of Alzheimer’s Disease International Toronto, Ontario March 2011 Janice Robinson, RN, MN, GNC(C) Clinical Nurse Specialist The Lodge at Broadmead, Victoria, BC, Canada. - PowerPoint PPT Presentation
Transcript of Dying with Dementia Integrating a Palliative Approach
Operating The Lodge at Broadmead and Veterans Health Centre
Dying with Dementia Integrating a Palliative
Approach26th Conference of Alzheimer’s Disease International
Toronto, Ontario March 2011
Janice Robinson, RN, MN, GNC(C) Clinical Nurse Specialist
The Lodge at Broadmead, Victoria, BC, Canada
Operating The Lodge at Broadmead and Veterans Health Centre
Operating The Lodge at Broadmead and Veterans Health Centre
Janice Robinson, RN, MN, GNC(C)Clinical Nurse SpecialistThe Lodge at Broadmead
Has no real or apparent conflicts of interest to report.
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The Lodge at Broadmead
Home to 225 people 60% Veterans 75% have Cognitive Impairment 100% have families Non-profit residential care
[complex care] Committed interdisciplinary
team Learning organization Dementia Care Project – funded
by Veterans Affairs Canada since 2003
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Workshop Goal – To increase caregivers capacity to provide excellent care through to death, through the application of palliative care principles, specifically focusing on issues that are unique to caring for people with dementia.
The Dementia Difference: A palliative approach to caring for people with late-stage dementia
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Challenges to implementing a palliative approach
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How to communicate with people with late stage dementia
How you know when a person with dementia is dying
Responding to a concerned family member If there are different views on what is
“best” for the person with dementia
Challenges to implementing a palliative approach – workshop
participants
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Shifting language away from labelling Consistent messaging Differing understandings amoung staff
regarding what is ‘best’ practice Making meaning for people with late stage
dementia
Challenges to implementing a palliative approach – workshop
facilitators
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Recognition – acknowledged, known by name Play – exercise in spontaneity & self-
expression Timalation – interaction that is primarily
sensory Celebration – any moment that is joyful Relaxation – may need to ‘relax’ with others
around in order to feel safe Facilitation – enabling people to do what
otherwise they would be unable to do Kitwood, T. (1997)
StrategyPositive Person Work
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Listen Acknowledge the person’s feelings Talk about the ambiguous dying syndrome
StrategyHonest, clear, compassionate
information sharing
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1. Overall trajectory will be a decline.2. Death is certain.3. Co morbidities will affect the trajectory.4. Certain interventions are ineffective in
late stage dementia.5. There are indicators that often precede
the active dying phase.
StrategyFocus on the certainties of dying
with dementia
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Changes in status – ask the question Communicate to family members Involve the interdisciplinary team Ensure adequate symptom management –
BEFORE this question…
Strategy“Could he/she be dying”
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CPR Gastric tubes IV antibiotics Hospitalization
StrategyNon-effective interventions
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The Dementia Difference in practice
Keeping death on the table Balancing living and dying Policies to support evidence – especially
regarding ineffective interventions for people with late stage dementia
Guidelines to support symptom management
Not labelling people “palliative”
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More written information for staff and family members
Education for volunteers
Continue to grow a culture that embraces a palliative approach
Growing the EOL program - our next steps
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Contact Information
Janice Robinson, RN, MN, GNC(C)Clinical Nurse SpecialistThe Lodge at [email protected]
Thanks to Veterans Affairs Canada for
generously funding of the BCS Dementia Care Program since
2003
