Bridging Biomedical and Person-centered Care Approaches via Namaste Care with Family Participation: An Asian Experience in Advanced Dementia Treatment

Abstract

A locally-adapted, multisensory, psychosocial intervention called Namaste Care program was developed to improve the daily life of persons with advanced dementia (PwAD) through arranging meaningful activities and physical interactions by healthcare staff (Namaste Carers). Congruent with Asian values, the families of PwAD were invited to participate in Namaste Care sessions. The study aimed to explore the influence of Namaste Care on cognitive status and quality of life (QOL) of PwAD, and perceptions and attitudes of caregivers and Namaste Carers toward dementia care were determined. A total of 10 individuals, including patient-caregiver dyads (n = 4) and Namaste Carers (n = 6) participated in a program in a tertiary hospital in Singapore. Quality of Life in Late-Stage Dementia (QUALID) scale and Severe Impairment Rating Scale (SIRS) were employed to evaluate QOL and cognition, respectively, in the pre- and post-survey program in patient-caregiver dyads. Namaste Carers’ knowledge and attitudes toward PwAD were assessed using the Questionnaire on Palliative Care for Advanced Dementia (qPAD). Caregivers and Namaste carers were interviewed post-program separately. A concurrent explanatory mixed-method analysis was done. The mean age of PwAD was 84 years, with 75% (n = 3) patients on enteral tube feeding. Namaste carers were nurses with an average experience of 4.1 years in dementia care. On comparison of pre- and post-program scores of PwAD, QUALID scores showed a decrease (indicating an improvement in the QOL), while the SIRS scores were increased (indicating an improved cognitive response). Namaste Carers scored high on qPAD, reflecting the good understanding and a positive attitude toward PwAD. Thematic analysis of 10 interview transcripts from caregivers and Namaste Carers revealed three themes: the polarizing paradigm of care in advanced dementia; pre-eminence of the Asian family values, and theme of “small actions make a big difference”. Namaste Care served as a bridge between the person-centered care approach and the biomedical model of dementia care. Namaste Care with family participation may be the cornerstone of PwAD to receive culturally-appropriate personalized care and serve as a premise for the operationalization of person-centered care in Asian societies, and undeniably across the world.

Exploring Differential Perceptions and Barriers to Advance Care Planning in Dementia among Asian Patient–Caregiver Dyads—A Mixed-Methods Study

“…There seems to be an implicit understanding that caregivers will know the preferences and wishes of PWD though no prior discussions had occurred. Our findings concur with two local studies that highlight the influence of the family unit in the decision-making process [ 54 , 59 ], thus reinforcing the prominence of a collectivistic culture among Asians [ 60 , 61 ]. A family-centered ACP model, involving PWD and their caregivers, also has been reported to be suitable for Asian countries with a predominantly Chinese culture, where relational autonomy often times supersedes personal autonomy [ 62 ].…”

The Perceived Impact of the Namaste Care Family Program on Nursing Home Residents with Dementia, Staff, and Family Caregivers: A Qualitative Study

“…Previous studies with the original Namaste Care have also shown a positive effect of the program on challenging behavior, 17 ‐ 21 , 34 mood, 25 , 35 , 36 engagement, 22 , 25 , 34 , 36 interaction, 25 , 34 and quality of life. 25 , 37 , 38 The calm environment along with the undivided personal attention and meaningful activities may have contributed to this, as others have suggested. 39 , 40 Incidentally, NCF had a negative impact on residents, which was mostly due to them needing to get used to NCF or could be ascribed to a mismatch between the activity offered and the resident's preferences and needs.…”

“…Previous studies with the original Namaste Care have also shown a positive effect of the program on challenging behavior, [17][18][19][20][21]34 mood, 25,35,36 engagement, 22,25,34,36 interaction, 25,34 and quality of life. 25,37,38 The calm environment along with the undivided personal attention…”

“…22,25 The themes identified for staff are connected and capture a shift to person-centered care through increasing their awareness of the importance of residents' wellbeing and personal attention, knowing their residents better, and establishing or improving bonds with family caregivers. 34,38 This indicates that NCF may be a suitable intervention to address some of the challenges nursing staff experience when providing palliative care to nursing home residents with advanced dementia. [13][14][15] A strength of our study includes using various perspectives by interviewing different stakeholders from all nursing homes, also the ones that prematurely ended the program.…”

Feasibility, acceptability, and preliminary effectiveness of the adapted Namaste Care program delivered by caregivers of community-dwelling older persons with moderate to advanced dementia: a mixed methods feasibility study

“…Caregivers in the present study perceived that the program helped them to incorporate structure and creativity in engaging in activities with persons with dementia, improved their understanding of meeting the needs of their family members, and brought them closer in their relationships through mutual enjoyment of activities. Other studies exploring the experiences of family caregivers in participating in delivering Namaste Care in LTC similarly found that they formed improved connections with persons with dementia through the program and preferred delivering activities in which they shared personal interests such as games [30,92].…”