Chronic disease self-management support for persons with dementia, in a clinical setting

Abstract

The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person’s ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient’s current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient’s skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.

The impact of cognitive impairment in dementia on self‐care domains in diabetes: A systematic search and narrative review

“…It is therefore necessary to thoroughly assess patients' cognition, including measures of attention and information processing, language, visuospatial ability, praxis, learning and memory, and executive function . Decrements in these domains drive poorer self‐efficacy and self‐care, further complicated by concomitant comorbidities such as depression …”

“…Self‐management and self‐care are often used interchangeably. In this review, self‐care is defined as comprising 5 core skills including problem solving, decision making, resource utilization, interacting with health care providers, and taking action (Appendix 2). Within these domains, we have allocated HbA1c levels, diabetic management knowledge, hospital admissions, hypoglycaemic and hyperglycaemic events, undertaking recommended screening, and the ability to manage independently as measures of self‐care.…”

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

“…The involvement of dementia caregivers is the key element of the selfmanagement strategies for chronic diseases in PWD. 11 Therapeutic interventions involving both the PWD and their caregivers (also referred to as the "dyad" in this paper) that include a combination of intervention strategies have been developed in the last two decades. 14,15 Available evidence shows that dyadic interventions for PWD and caregivers had beneficial effects on their psychological well-being.…”

“…Thus, PWD reply on the help of their caregivers for care management. Because of the progressive loss of cognition and declining physical functions, PWD require a high level of care over time, and self‐management becomes the responsibility of the caregivers . Since the majority of the PWD lives at home, dementia care has usually been provided by informal caregivers .…”

“…Because of the progressive loss of cognition and declining physical functions, PWD require a high level of care over time, and self-management becomes the responsibility of the caregivers. 11 Since the majority of the PWD lives at home, dementia care has usually been provided by informal caregivers. 12 Many dementia caregivers pay for the cost of their own physical, mental, and social well-being when taking on dementia caregiving roles.…”