What is it about?
Dementia is a rising issue worldwide; people living with dementia (PwD) can live for a very long time with their mental capacity gradually declining. There will come a point when they cannot make decisions for themselves; families and healthcare staff will have to make the decisions for them but the decisions that are made may not be what PwD want. This is a review of what affects PwDs’ decisions to talk about their future plans looking from 5 perspectives: 1) PwD, 2) their family, 3) healthcare team, 4) system or wider view and, 5) time.
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Why is it important?
Planning for future care amongst PwD involves several people. It is necessary to understand their interrelationships, and how those factors affect those plans. We found that in order to talk about it effectively, healthcare teams need to know more about the dementia trajectory and how to talk about future plans with PwD, informally, over time. Timing to talk about it is also another huge gap in literature: when would be the best time to talk about this with them? We don’t know (yet).
Perspectives
I have two perspectives for this work: the complex interaction between these factors, and the narrative review approach. 1) No one lives in a social void; you are always connected to someone. For PwD, it is particularly important since their decisions must be known to others too before they cannot communicate. The systemic view also highlights how the system impacts the context of care and that we need to customise our care individually: tailor-made care. 2) There is an ongoing discussion of the definition of this work and the hierarchy of evidence in academia. In my opinion, this is a narrative review with enhanced methods to reduce the limitations of this approach. This name (narrative review) is a red herring and we should focus on the findings and conclusions that have been drawn upon rather than the definition.
Dr Tharin Phenwan
University of Dundee
Read the Original
This page is a summary of: A narrative review of facilitating and inhibiting factors in advance care planning initiation in people with dementia, European Geriatric Medicine, April 2020, Springer Science + Business Media,
DOI: 10.1007/s41999-020-00314-1.
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