Dementia, dignity and quality of life: nursing practice and its dilemmas

Abstract

The opportunity to debate the subject and to discuss practice examples revealed differences of opinion and moral perspectives between practitioners about the use and relevance of the term dignity. These need to be acknowledged in any debates about objective and subjective definitions of quality of life.

Dignity-preserving dementia care

“…Randers and Mattiasson 26 found this base of knowledge essential for caregiver ability to see the patient as a unique individual in a unique situation. They underline the importance of empathizing with the person as a foundation for dignity preservation, advocating his autonomy and integrity as a state of wholeness: Knowledge and empathy were also the main results in Manthorpe et al, 1 showing how professional caregivers emphasized person-centeredness in dementia care. They identified professional insight into the elements that constitute each person's subjective dignity as crucial in enhancing dignity in dementia care.…”

“…A genuine interest in the individual person, combined with professional knowledge and caring attitude, was recognized as caregiver qualities and competence crucial for dignitypreserving dementia care. 1,26,27,30,32 In their study, Borbasi et al 27 found how professional knowledge concerning the fundamental needs in persons with dementia in general, supplemented by knowledge about the individual person hospitalized in particular, were fundamental insights toward helping nurses and allied HCP to advocate the individuals' autonomy and integrity. Randers and Mattiasson 26 found this base of knowledge essential for caregiver ability to see the patient as a unique individual in a unique situation.…”

“…1 However, the concept of dignity and its practical applications for care have been criticized for vagueness and insufficient documentation. 2 Dignity is not easily placed under the microscope and defined.…”

“…Manthorpe et al 1 Talking to him or her in ways that enable him or her to find the best way to break the news of diagnosis to the family; maintaining the person's trust and confidence by respecting his need to feel in control; despite apparent deception, finding and retaining the person's sense of status in own eyes; supporting the individual in a person-centered way to understand the subjective elements of the person's dignity; respecting the person's need of sex and intimacy in a context of worthiness; being self-reflected and think about what you have wanted if put in a similar situation; acting as the person's advocate; and developing and implementing an agreed care plan based on cooperation involving the person, the relatives, and healthcare professionals 9. Rodriquez 32 Using emotional attachment as a resource to construct dignity experience in themselves as caregivers, and in the residents and treating residents as dignified individuals who deserve respect and are worthy of care, even if it may appear otherwise…”

Factors influencing quality of life of elderly people with dementia and care implications: A systematic review

“…This suggests that autonomy is a positive predictor of higher QoL of elderly people with dementia cared by other people. Other factors influencing a positive QoL of elderly people with dementia are related to needing some control over their life in dementia care (Moyle et al, 2011;Moyle et al, 2015), enforcement of dignity (Manthorpe et al, 2010;Venturato, 2010;Russell et al, 2008), respecting their personhood (Venturato, 2010), and being useful and contributing to society (Moyle et al, 2011;O'Rourke et al, 2015;Byrne et al, 2006;Silberfeld et al, 2002). Besides, Dawson et al (2012) pointed out 22 that greater self-efficacy perception (inner stength and personal growth) of elderly people with dementia also positively affect their self-rated QoL.…”