Book: Communication in Care

As dementia progresses, there is an awareness that medical crises may arise. People with dementia are not always able to participate in meaningful discussions and in the absence of advanced care planning, Carers become proxy decision makers. Anticipating needs and looking ahead may lead to greater resolutions in times of crisis

A dementia related crisis is when there ‘is a stressor(s) that causes an imbalance. It needs an immediate decision which to resolve the crisis. If the crisis is not resolved, the cycle continues’, Vrooman, et al (2013).

It is beyond the scope of this course to identify all possible crises but in Later Stage dementia it may include

·         Acute medical conditions such as fainting and collapse, pneumonia, urinary tract infections, and dehydration and malnutrition.

·         Falls and hip fractures are associated with emergency hospitalization and nursing home placement in persons with dementia

·         Behavioural and psychological symptoms of dementia are ‘stressors’ which lead to crisis situations 

Acknowledging and anticipating that these ‘crises’ will probably occur is an important step. Advance communication with General Practitioners and PHN is a key point. They can offer information, expertise and support about dementia and the Later Stages

·         They can give information on respite care and home support services. Without such services the crisis may lead to over-burdened caregivers and to unplanned institutionalization or emergency hospital admission

·         Carers can reflect about how they are feeling; in regard to their caring role and also about their own health, how they themselves are managing.

Decisions about the care of people with Later Stage dementia should be through consensus among healthcare professionals and family carers, with considerations of the persons known or perceived wishes, beliefs and values, as discussed in Unit 3.