Evidence and Practice

Clinical

Delivering personal care for people with advanced dementia

Delivering personal care for people with advanced dementia

Why you should read this article: • To recognise that meeting the increasing fundamental care needs of people living with advanced dementia is essential to their well-being • To be aware of the need for partnership working with people living with advanced dementia and their families in care planning, implementation and evaluation • To identify strategies to deliver asset-based personal care interventions This is the second article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article considers the complexity of providing personal care, including the need for expert nursing practice to assess and lead the fundamentals of care: washing, dressing, continence care, nutrition and hydration. The contemporary evidence base for effective assessment, care planning, partnership working and evaluation of personal care for people with advanced dementia is presented, supported by sources of further information.

A day in the life of an advanced clinical practitioner in older people’s care

A day in the life of an advanced clinical practitioner in older people’s care

A reflective account of advanced clinical practice in an older person’s unit

Nurses’ attitudes towards caring for people with dementia in acute hospital settings: a literature review

Nurses’ attitudes towards caring for people with dementia in acute hospital settings

A literature review into the attitudes of nurses who care for patients with dementia

Advance care planning and decision-making in dementia care: a literature review

Advance care planning and decision-making in dementia care: a literature review

Why you should read this article: • To enhance your knowledge of the literature on advance care planning (ACP) in dementia care • To be aware of the potential benefits of ACP for people living with dementia and their carers • To recognise the barriers and enablers to undertaking ACP, and how these could be addressed Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts

AONPs: the potential to improve outcomes for older people with cataracts

The advanced ophthalmic nurse practitioner is well-placed to provide high-quality care

Urinary tract infection prevention: evaluating Scotland’s national hydration campaign

Urinary tract infection prevention: evaluating Scotland’s national hydration campaign

Understand the challenges posed by urinary tract infections in older people

CPD articles

Type 2 diabetes in older people: pathophysiology, identification and management

Type 2 diabetes in older people: pathophysiology, identification and management

Exploring the implications of increased longevity and how this is linked to type 2 diabetes

Sexual health and well-being in later life

Sexual health and well-being in later life

This article defines sexual health and explores the changes people experience in later life

Extending the Newcastle Model: how therapeutic communication can reduce distress in people with dementia

How therapeutic communication can reduce distress in people with dementia

Newcastle Model’s biopsychosocial framework is revisited to understand the caregiving context

Osteoporosis and fragility fractures: risk assessment, management and prevention

Osteoporosis and fragility fractures: risk assessment, management and prevention

Nurses need to be aware of the risk factors and identify at-risk patients

Understanding and managing depression in older people

Understanding and managing depression in older people

Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.

COPD

Helping people live with chronic obstructive pulmonary disease

How nurses can have a positive effect on the lives of people with COPD

How to

Hearing loss

How to address the communication needs of older patients with hearing loss

Hearing loss is a common problem in older people and may have a negative effect on their care while in hospital, as well as resulting in significant cost to the NHS. This article outlines the findings of a two-year project in an NHS trust to improve the care of older people with hearing loss. An important outcome of the project was the development of a hearing loss toolkit containing good practice recommendations and tools to help staff in all NHS trusts, and other care settings, implement practical and cost-effective improvements.

Planning

How to use advance care planning in a care home

Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.

Practice question

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How can I ensure dementia care is based on the best available evidence?

Critically appraised topic (CAT) process helps ensure clinical practice is evidence-based

Nurse attending to an older patient who is experiencing and needs hydration

How do I manage the care of an older person with delirium?

Guidelines recommend prompt detection by screening older people on admission to hospital

Many older people use multiple medicines, medicines optimisation helps to ensure safe and appropriate polypharmacy

Why is medicines optimisation important for older people living with frailty?

Medicines optimisation can help ensure appropriate polypharmacy

www.resus.org.uk/faqs/faqs-dnacp

How should I discuss not attempting CPR with people who have dementia?

Discuss the wishes of people with dementia proactively due to its progression

Picture shows a care home supervisor talking to a resident. Healthcare professionals can help meet the needs of older people approaching the end of life by asking the right questions.

Surprise questions that can improve end of life care

Older people approaching the end of life can be helped by asking the right questions

Push-on mower

Care home residents can benefit from carrying out everyday activities

Safety concerns prevent care home residents doing everyday tasks that benefit them

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