Ladislav Volicer

This chapter provides a rationale for the use of palliative care for persons with dementia that does not eliminate concomitant curative care of comorbid conditions. The goal of palliative care is the maintenance of quality of life by person-centred care that stresses the remaining abilities rather than disabilities of the person. Quality of life is enhanced by providing prognostic information and by avoiding aggressive medical interventions that cause more burdens than benefits and are not in agreement with goals of care. Quality of life is also enhanced by meaningful activities that provide psychosocial and spiritual support and by appropriate management of behavioural symptoms. The chapter also stresses the importance of family care and involvement, and of health care team education.

Analysis of a relationship between wandering and involvement in meaningful activities in nursing home residents with cognitive impairment. Cross-sectional analysis of the minimum data set information. The analyses were conducted on 8 nursing homes in the Netherlands. The participants were residents aged 65 years and above with an evidence of cognitive impairment. Items in the minimum data set related to wandering behavior, involvement in activities, presence of psychotic symptoms, and treatment with antipsychotics. Ambulatory residents who exhibited wandering were divided into: those whose behavior was easily altered [modifiable wandering (MW)] and those whose wandering behavior was not easily altered by the staff [nonmodifiable wandering (NMW)]. The duration of time for which they had opportunity to be involved in meaningful activities was estimated from involvement in activities of nonambulatory residents. The prevalence of wandering increased with severity of cognitive impairment. MW was present in 3.5% of total residents (8.5% of ambulatory), whereas NMW was present in 11.2% of the total ambulatory and nonambulatory residents (26.6% of ambulatory). The risk of NMW was increased with resistiveness to care and decreased with antipsychotic use. Individuals with NMW were less involved in activities. NMW was more prevalent in facilities in which residents were involved in activities for a shorter duration. Involvement of residents in meaningful activities should be tested for reducing the incidence of problematic wandering and for decrease in usage of antipsychotic medications.

Objective: The aim of this study is to analyze modifiable factors related to agitation of nursing home residents with dementia.Methods: Relationship of agitation with three modifiable factors (depression, psychosis, and pain) was explored using longitudinal Minimum Data Set (MDS) information from 2032 residents of Dutch nursing homes. Presence of agitation and depression was ascertained using validated scales based on MDS information. Presence of psychosis and pain was ascertained from the individual MDS items.Results: There was a significant correlation between MDS depression and agitation scores. Depression scores increased in residents whose agitation worsened and decreased in residents whose agitation improved. Psychosis scores (combination of delusions and hallucinations) also correlated with MDS depression scores, and psychosis scores increased in residents whose agitation worsened. Pain scores correlated with agitation scores, but the pain scores did not change with changes in agitation. Depression symptoms were present in 51% of residents, while psychotic symptoms were present only in 15% of residents, and two‐thirds of these residents were also depressed.Conclusion: These results indicate that depression may be the most common factor associated with agitation in nursing home residents with dementia. Copyright © 2011 John Wiley & Sons, Ltd.

This chapter focuses on Namaste Care, a programme designed to improve the quality of life for residents living in institutional settings. It gives ‘voice’ to residents who can no longer speak and helps to ensure that the last stage of life is peaceful and comfortable in the presence of others. Residents have different values, wants, needs, and desires. Namaste Care is a 7-day-a-week ‘enhanced’ nursing programme. Activities of daily living (ADLs) are offered as ‘meaningful activities’.