Late stage dementia refers to a memory loss in its most severe form. A person experiencing dementia for the first time cannot be said to be in the late stage dementia. For one to be categorized under individuals with late stage dementia, he or she must have suffered from the condition for a couple of times until the symptoms become highly visible and worse in comparison to other times when dementia has been part of his or her life. This essay focuses on Mrs.Salis who has late stage dementia and who requires 24 hours’ palliative care in a residential facility. The notions of privacy, dignity, support, communication, and safety rights will be explored. In essence, Mrs. Salis has the right to safe and effective care in alignment with the five rights stated in the health and disability rights: privacy dignity, support, communication, and safety rights.
Mrs. Salis: An Overview
Being a patient of late stage dementia, the following may be some of the attributes exhibited by Mrs. Salis:
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Significant loss of memory where she may not even recognize key family members.
Need for assistance in eating and taking drinks.
Difficulties in speech.
Dozing regularly in the course of each day such that most of the times seem like her sleeping rather than wake time.
Gradual development of walking or moving inabilities.
Frequent hallucinations where she may feel, taste, or see inexistent things.
Unusual conduct, such as repetitive movements, restiveness, and unease.
Incontinency which implies a loss of control of one’s bowels and bladder thus the likelihood to mess oneself from time to time.
Ensuring Effective Care and Safety of the Patient
A patient of dementia may experience extreme symptoms in alignment with memory loss. They may not remember persons or issues close and important to them. Some forget their names and cannot are even identify some objects that they come across in their daily life. As such, the patient may feel vulnerable and unsure of the occurrences in her surroundings. Mrs. Salis in this case would, therefore, requires moments of reassurance. She needs to see someone around as a guarantee of her safety. When she experiences moments of recognition, the caretaker or someone close to her should spend that time to engage with her. According to the Alzheimer Society of Ireland (ASI), engagement depicts a sign of love and commitment and thus serves as part of effective and quality care for persons with dementia (ASI, 2015).
Dignity is an important aspect of the quality of life for persons with dementia, particularly in residential facilities. It refers to the feelings and perceptions of a resident in alignment with the care and treatment conferred to him or her. It is here that the right to privacy also applies. For Mrs. Salis, the demands may be high for her as she requires 24 hours care while in the residential facility. Some caretakers may portray the feeling that her demands are drilling and, therefore, fail to attend to her in her times of need due to the perception that she is a burden. This would be one way of denying her the feeling of self-worth and would only act to worsen her situation (Manthorpe et al., 2010).
In alignment with privacy, Mrs. Salis has a right to have her condition discussed only between her and close family members with her consent. Discussing her condition aimlessly with anyone else, particularly in her presence, would amount to a threat of her dignity. For instance, taking into consideration that such a person may have reached a stage where she cannot control her bowels (ASI, 2015), it would be a violation of her privacy if her caretaker just tells anyone about such incidences. Mrs. Salis should be kept in an environment that depicts her as important as any other person who is in her right minds and one whose life is worth despite the unattractiveness of her deeds or self-presentation (Manthorpe et al., 2015). This would give her a sense of hope and prolong her life amidst improvement of her condition due to feelings of self-worth and hence a strong self-concept.
Support demands that a person with dementia gets all the assistance she requires at any particular point. For Mrs. Salis, the caregiver should recognize every move she makes as all behaviors and deeds would be signs of communicating something (Alzheimer Society of Canada, ASC, 2016). While a person with dementia may sometimes act in an unusual way, such as depicting restlessness, such behaviors may be depictions of discomfort or anguish pain. The caretaker should be keen in trying to identify the source of the patient’s unusual conduct. Sometimes, the patient may only be agitating for a change of position while massage can at times be effective in creating calmness for him or her. Support may also be granted to the patient in walking as some patients lose their abilities to walk or move around. Being close to assist in such undertakings will be helpful in yielding gratitude and hope for the patient and improving her condition. Inability to walk around to engage in various endeavors may be one reason for taking a person with dementia to a residential facility where care can be offered 24 hours. This may be the case for Mrs. Salis and the caretaker, therefore, has to ensure his or her availability to offer the necessary support, including emergency care (ASC, 2016). Supporting the patient to be independent is basic to the patient’s well-being and effective care.
Communication is the most important aspect in the life of a person with dementia, whether mild or severe. It is one way through which to boost the patient’s independence in undertaking some activities. As part of aiding the communication process, individuals with late stage dementia should undergo the hearing and vision tests and where impairments are detected, a means of addressing the same, where possible, should be devised (National Center for Biotechnology Information, 2007). The sense of hearing and sight play a critical role in enhancing verbal and non-verbal communication. Where the patient cannot hear, the sense of sight is critical in enabling him or her to observe the non-verbal cues and respond appropriately. While some individuals in the late stage dementia will in most cases not speak, they often engage with their expressions, emotions, body language, and other non-verbal cues (ASI, 2015). Part of effective care for Mrs. Salis may include reading to her an interesting book even under circumstances when one is unsure about her capacity to understand the occurrences within her environment.
In alignment with safety rights, Mrs. Salis is not in a position to make important decisions that are critical to her quality of life. She may expose herself to danger unknowingly or even harm herself. Her safety relies solely on her caretakers and that is the main reason for being kept in a residential facility where care can be offered throughout. In case she goes missing, the caretakers would be accountable. As such, Mrs. Salis should have someone watching over her all the time to ensure that she stays within the residential facility. Her vulnerability to the dangers in her environment demand the availability of someone to cater to her needs, concerns, and grieves. Continuous engagement with a caretaker culminates into the development of a strong bond and a perception with the patient that someone cares (NCBI, 2007). Where the perception of care is boosted within a patient, there is feeling of safety and reassurance and this may create calmness with the patient which eases the job of the caretaker.
Summary
In essence, late stage dementia emerges as a highly demanding condition when one is a caretaker. Where the patient experience significant memory loss, it may emerge that the caretaker is the most trustworthy person for such a patient. One key point that seems helpful and a mandatory for safety and effective care of an individual with late stage dementia is communication. It is the only way through which to engage with the patient and enhance her trust. Adapting one’s communication style to fit the needs of the patient is particularly important. While most of the individuals with dementia will rarely use speech in their expressions, the non-verbal cues become the way forward in ensuring interaction and inclusiveness. It is important for a caretaker to be aware of the non-verbal cues that are mostly used by his or her patient in a bid to adjust appropriately.
From a personal perspective, I will be keen to adapt my communication style in cases where I have to deal with an individual who has dementia. Knowing that dementia has no cure and relies on the interaction between the patient and the caretaker to ensure the quality of life of the patient, I will commit myself to ensuring the satisfaction of such individuals through an assurance of safety, appropriate support, as well as protection of their privacy and dignity. It is only through communication that such patients can develop trust and hence the belief of the protection of their right and provision of effective care.
References
Alzheimer Society of Canada (2016). Living with dementia: Quality of life. Retrieved from http://www.alzheimer.ca/en/Living-with-dementia/Caring-for-someone/Quality-of-life
Alzheimer Society of Ireland (2015). Understanding late stage dementia. The Irish Hospice Foundation. Retrieved from https://www.alzheimer.ie/Alzheimer/media/SiteMedia/Helpline%20and%20Information%20Resources/Info%20Pack%20PDF%27s/Understanding-late-stage-dementia_Section-A6.pdf
Manthorpe, J., Iliffe, S., Samsi, K., Cole, L., Goodman, C., Drennan, V. & Warner, J. (2010). Dementia, dignity and the quality of life: nursing practice and its dilemmas. International Journal of Older People Nursing, 5, 235-244. Doi: 10.1111/j.1748-3743.2010.00231.x
National Center for Biotechnology Information (2007). Therapeutic interventions for people with dementia- Cognitive symptoms and maintenance of functioning. US National Library of Medicine, National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK55462/
