Maintaining Quality of Life for Residents with Dementia in Long-Term Care Settings - Abstract
Cognitive impairment compromises quality of life. This review will indicate how it is possible to maintain quality of life in resident with dementia who lives in a long-term care setting by providing appropriate care. This care must address three main factors: meaningful activities, neuropsychiatric behavioral problems, and medical issues. Meaningful activities must be provided by caregivers because residents with dementia cannot initiate activities they enjoyed in the past. The activities must be tailored to the severity of dementia, should be provided 7 days/week, and available also for residents with advanced and terminal dementia (e.g., by involvement in the Namaste Care). Physical and environmental causes of behavioral problems should be identified and eliminated. It is important to consider circumstances in which behavioral problems occur and distinguish between agitation and rejection of care because they could be prevented by different interventions: agitation by involvement in meaningful activities, and rejection of care by improved communication and changes in care strategies. Depression increases risk of both symptoms and should be effectively treated. Treatment of medical problems should take into consideration goals of care determined by residents or their families, and that any medical intervention may cause discomfort. Therefore, interventions that do not meet goals of care and cause discomfort
should be eliminated. There is no evidence that cardiopulmonary resuscitation and tube feeding are beneficial in advanced dementia. Mobility should be maintained for as long as possible because it improves ability to participate in meaningful activities and decreases the risk of medical problems, e.g. inter current infections and pressure ulcers.