Personalised care for people with dementia

Five principles on improving care for people with dementia and their families are set out in a new RCN document

Essential facts

The term dementia is used to describe more than 100 different conditions that affect the brain and result in an impairment of function. People affected may experience memory loss, problems with communication, impaired reasoning and difficulties with skills for daily living. Dementia is a progressive and terminal condition. In the UK, 850,000 people are estimated to be living with dementia.

What’s new?

Five principles that form a shared commitment to improving care for people with dementia and their families are set out in a new RCN document.

Each of the principles in SPACE – an acronym for staff, partnership, assessment, care and environments – is considered essential to ensure the appropriate delivery of care. They are applicable across all health and social care settings. The principles are:

1. Staff who are skilled and have time to care – staff need good training and education that is easy to access, practical and focuses on attitudes and approach, and is based on recognised guidelines.
2. Partnership working with carers. Effective care requires a relationship-centred approach, which acknowledges the needs of families and carers.
3. Assessment, early identification of dementia and post-diagnostic support. Systematic identification of people with cognitive impairment is also likely to improve the detection of delirium and depression, opening opportunities to support them better. Types of assessment that may be required include swallow or speech and language assessment, continence assessment, rehabilitation needs, advance care planning and decisions about end of life care.
4. Care and support plans that are person-centred and individual, ensuring that care is based on the individual’s needs. Their biography, preferences and an understanding of their abilities are important.
5. Environments that are dementia-friendly. Unfamiliar environments such as in a hospital, care home or hospice can be difficult for people with dementia. Environments should be dementia-friendly and support independence and well-being.

Implications for nurses

• Rather than seeing a patient as ‘someone with dementia’ it is essential to seek to understand the individual. Knowing and respecting each person remains central to the relationship.
• Careful consideration is needed for staffing levels to ensure that this skill mix, ratio and numbers of staff are adequate to support the complex needs and numbers of people with dementia being cared for.
• Good quality training and education in dementia involves listening to the way people with dementia want to be cared for and hearing the views of family carers. Surveys reveal that staff’s lack of understanding and time were the major barriers to achieving this.
• Family carers also have their own needs, which should be assessed and considered.
• Assessments of people with dementia should be supported by use of agreed screening and assessment tools, a clinical review of medication and ensuring that antipsychotic medication is only used as a last resort and on a short-term basis.

RCNi dementia articles

Find out more

• Dementia UK – What is an Admiral Nurse and how can they help?
• National Institute for Health and Care Excellence (2018) Dementia: assessment, management and support for people living with dementia and their carers
• RCN (2019) Commitment to Care of People Living with Dementia: SPACE Principles