Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy

Abstract

Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole.

Emotional upheaval, the essence of anticipatory grief in mothers of children with life threatening illnesses: a qualitative study

“…However, unlike the results of the previous studies, in the study by Ounalli et al [17] it was found that when a child develops a life-threatening illness, parents use longterm strategies to cope with imminent death. They try to adapt to the shock and hopelessness and, while preparing for the possible death of their child, help their child experience less pain and endure it.…”

The experience of children with a parent suffering from Amyotrophic Lateral Sclerosis during the COVID-19 pandemic

“…Certainly, some studies done on continuing bonds have shown how these allow an individual to better overcome the suffering of mourning 80 , 81 . Originally, the project planned to develop representations of death by expanding the horizon to include reflection on transcendence to allow minors to think that death does not mean the absolute loss of a loved one, as death education experiences have shown 82 – 84 .…”

Informed consent with people judged incapable of legally consenting

“…The practitioner engages in a semistructured interview where a preliminary dignity document is created, which is then edited together with the client, and returned to the client to have and share with family as they see fit. Ounalli et al (2020) stated that dignity therapy is easily modified for those experiencing cognitive impairment, as palliative care should not be considered an intervention for only the dying, but a response to clinical suffering. The intervention can look at the issues of dignity in the context of the losses that those with cognitive impairment may be suffering without parentification or infantilization of the individual.…”