Personalising care with older people who have cognitive changes or dementia

Impaired cognition is complex; it can be temporary, degenerative and static and/or fluctuate. Considered, collateral, individualised assessments, accurate diagnosis and regular reviews in consultation with the person and their carers are vital to help to determine appropriate personalised management and care. An older person’s life story, including past social and medical history are as important as their current circumstances. They provide context for their plan of care and personalised treatment. Capturing this information can help carers to focus on the person’s strengths and support their wishes. Impaired cognition does not replace an individual’s right to self-determination or prevent them from expressing their preferences and participating in care decisions. Situations can be fraught as cognition declines or is acutely compromised. Importantly, the contribution carers make and the significant care work professional and family carers undertake should never be taken for granted Proactive engagement with older people and their carers in the early stages of cognitive decline as well as during ‘windows of clarity and lucidity’ are the ‘right times’ to plan, document and share information. The principles of dignity and respect can be used to guide and support older people, their carers and health professionals to make choices, promote independence and minimise risk. Care needs to be goal-directed, holistic, personalised, realistic, and adaptable to accommodate changing circumstances. Sometimes carers have to change their expectations. Lateral thinking and creative, practical strategies can help address problems and decide effective outcomes.