Cognitive Impairment and Dementia in Practice
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Cognitive Impairment and Dementia

What we know

Palliative care of older people includes assessing and responding to cognitive issues such as confusion, delirium, mild cognitive impairment, dementia and/or communication difficulties. Dementia is recognised as a life-limiting condition for which palliative care is appropriate and beneficial. Planning for future changes should be initiated before a person’s decision-making capacity becomes impaired or as soon as possible after a diagnosis of dementia. Most people with dementia have co-existing long-term health conditions and these will also contribute to the person’s level of impairment and need for assessment and monitoring.

What can I do?

For the person with dementia

Remember to look beyond dementia and understand that a person living with dementia is still a person and so are their carers.

If a person with dementia cannot communicate, they may respond well to sound and touch.

For the assessment of pain, use tools such as the Abbey Pain Scale (1.08MB pdf), PAINAD (27kb pdf), Doloplus (25kb pdf) and reports from family and carers - see Pain in Residential Aged Care Facilities: Management strategies (requires payment but Executive summary is free).

Use the Integrated Palliative care Outcome Scale for Dementia IPOS-Dem for regular assessment of aged care residents with dementia.

Use the Dementia Training Australia Responsive Behaviours Quick Reference Cards to assess and respond to Behavioural and Psychological Symptoms of Dementia (BPSD) or responsive behaviours.

Use the following tools to screen for cognitive impairment:

Use the ELDAC Dementia Toolkit to plan and provide care.

When responding to changed behaviours or psychological symptoms related to dementia focus on the underlying causes which may be unmet physical, social, or environmental needs. Do not use the term BPSD to describe a specific behaviour or symptom.

For family and carers

Check if people in your care with moderate to severe levels of cognitive impairment associated with dementia or other conditions, cared for at home, are eligible for the dementia and cognition supplement.

Recognise the important role of the family and carer(s). Tell families they can find high-quality and trustworthy dementia resources and information at healthdirect, Dementia Australia and Dementia Support Australia.

Suggest the Dementia-friendly home app.

Recommend the A Better Visit app to assist with engaging the family members with a resident with dementia.

Remember family members and carers may need to know of options for respite care.

palliAGED Tip sheets

Tips for Careworkers:
Advanced Dementia
 
Tips for Careworkers:
Advanced Dementia - Behavioural Changes
 
Tips for Nurses:
Advanced Dementia
 
Tips for Nurses:
Advanced Dementia - Behavioural Changes

What can I learn?

To understand dementia from the person’s perspective, listen to this podcast from Theresa Flavin for NPS MedicineWise about changed behaviours.

Read the guide about palliative care identification tools for use with people living with dementia (232kb pdf) from Healthcare Improvement Scotland.

Check the RACGP Silver Book sections on Dementia and Behavioural and psychological symptoms of dementia for practical guidance on care issues.

Careworkers who provide home support for people living with dementia can use Ask Annie, an app from Dementia Australia which offers practical tips and tools.

Use Dementia Australia Help Sheets and Dementia Support Australia resources for advice and practical strategies to support a person with dementia.

For tips on medicines and other modalities to help improve the quality of life of residents living with dementia, listen to this podcast from Kara Joyce who delivers dementia education programs for NPS MedicineWise.

Use the education and training resources in the ELDAC Dementia Toolkit

Watch these videos:

Read Lloyd-Williams M, Dening KH, Crowther J. Dying with dementia—how can we improve the care and support of patients and their families. Ann Palliat Med. 2017 Oct;6(4):306-309. doi: 10.21037/apm.2017.06.23.

Read Palliative Care and Dementia (974kb pdf), a report for Dementia Australia which provides guidance on palliative and end-of-life care for people with dementia and those who support them.

Training modules

Check out the training and education modules offered by Dementia Australia.

Check out the dementia-specific training learning modules from Dementia Training Australia.

Access the dementia-specific training module and resources from The Advance Project.

What can my organisation do?

Ensure that you provide a dementia-friendly environment (100kb pdf) for people in your care.

Look at how the physical built environment and the social environment can be optimised. This may include:

  • room temperature
  • light levels
  • noise levels
  • homely environment and ambience
  • options for activities that are interesting or meaningful for the person
  • care staff stability
  • supports for the development of positive interpersonal relationships between care giver and care recipient
  • presence of supportive and responsive leadership
  • observation as to responses of the person with dementia to care staff, visitors, food, the physical environment, so that changes can be made accentuating the positive responses and eliminating the negative responses.

Use Dementia Support Australia resources on engagement and design to optimise care for people with dementia.

Unnecessary hospitalisation may increase the likelihood of delirium developing. Before organising a hospital transfer, confirm the client’s or resident’s wish.

So that treatment is in line with wishes and preferences, ensure that there are clear processes:

  • for people with capacity to document their preferences for care
  • for people who no longer have capacity, that substitute decision-makers are nominated
  • that care plans are regularly reviewed.

Promote awareness of:

  • Behaviour Support Plan resources from Dementia Support Australia
  • Dementia Behaviour Management Advisory Service (DBMAS) 1800 699 799
  • Centre for Dementia Learning 1300 DEMENTIA (1300 336 368)
  • the dementia-specific training learning modules from Dementia Training Australia for aged care staff, health care professionals, undergraduate trainees, and a range of other professionals and community service providers.


Page updated 21 September 2022