Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative

Abstract

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.

The provision of accredited higher education on dementia in six European countries: An exploratory study

“…Dementia care is provided by a wide variety of professionals from different disciplines (Hvalič Touzery et al, 2015), many of whom lack education about working with people with dementia (Gandesha et al, 2012;Ibrahim and Davis, 2013;Adler et al, 2015;Hanson et al, 2016;Tolson et al, 2016). This is particularly acute amongst those professionals (nurses, social workers, psychologists, dieticians, nurses, occupational therapists and physiotherapists) who work outside mental health (Pulsford et al, 2007;Griffiths et al, 2014).…”

“…The fourlevel framework outlines the knowledge, skills and understanding all health and social care staff should have to support people with dementia, their families and friends. There has also been a European Best Practice Statement developed to support interdisciplinary healthcare professionals to deliver advanced dementia care (Tolson et al, 2016). Both of these are useful for supporting the development of practice however it is up to the discretion of employers whether and to what extent they embed these frameworks into the education and training of staff.…”

The relationship between frailty, functional dependence, and healthcare needs among community‐dwelling people with moderate to severe dementia

“…Frequently, needs assessment separates the evaluation of different people (professionals, family caregiver, and person with dementia) (Callahan et al, 2006;Johansson, Eklund, & Gosman-Hedstrom, 2010). The assessment of needs should be taken into account the past life experiences, cultural background, preferences, and identities (Holmerova et al, 2016) and joint together the recipient of needs, the caregivers, and the professionals (Dinand, Nover, Holle, Zischka, & Halek, 2016).…”

“…Evidence has shown that planning for advanced dementia is often not undertaken (Holmerova et al, 2016;Tolson et al, 2016), due to a lack of consistent information. A comprehensive assessment of the healthcare needs is indispensable to decisions related to the provision of quality care.…”

“…The challenge of a comprehensive health care needs assessment cannot be underestimated; when professionals believe that all changes affecting the person are related only to dementia, fundamental health needs can easily be missed (Holmerova et al, 2016).…”