Who am I? Identity, person-centred care and dementia.

Identity is a central aspect of our lives. Who we believe ourselves to be has profound implications on how we interact with and interpret the world around us. People with dementia often experience stigma and suboptimal care because of a perception that they have 'lost their identity' as the cognitive symptoms associated with the condition progress. This notion is challenged by proponents of person-centred care who argue that a person's identity and worth are based on more than cognitive abilities. Person-centred care is a holistic approach that takes account of the entirety of a person's life and provides support that respects the individual and their self-identity. Since identity is vital to well-being, delivery of person-centred care must involve actively seeking a person's concept of self to tailor their care to meet all their needs. This article considers the importance of identity and personhood for people with dementia and their carers in the context of person-centred care. The article includes two case studies to illustrate these concepts in practice.

Implementing post-diagnostic support for people living with dementia in England: a qualitative study of barriers and strategies used to address these in practice.

BACKGROUND: inequalities and gaps in post-diagnostic support (PDS) for people with dementia persist despite a policy focus on dementia in England and Wales. Understanding and overcoming the factors contributing to these inequalities is vital to improve care for people living with dementia (PLWD) and their families. OBJECTIVE: to explore common barriers to the delivery of PDS in England and Wales and describe successful strategies to address them, drawing on examples from current practice. DESIGN: qualitative semi-structured interviews, focus groups and observation. SETTINGS: Phase 1: interviewees were drawn from multiple sectors across England and Wales, including NHS clinical commissioning groups and social care. Phase 2: six case study sites based in different sectors (primary care, secondary mental health and third sector) in England. PARTICIPANTS: Phase 1: 61 professionals, including commissioners and service managers. Phase 2: 68 professionals, including frontline staff and those working in related services; 17 PLWD; 31 carers. RESULTS: barriers to implementing PDS in dementia were an unsupportive infrastructure, limited proactive review and limited capacity and capability particularly in primary care. Strategies used successfully in practice to address these challenges included creating opportunities for service development, improving joint working, supporting non-specialists and developing ongoing, holistic review and care planning. CONCLUSION: a range of practical strategies have been identified to address many of the common barriers to PDS in dementia. To achieve policy goals of a task-shifted and task-shared approach to PDS, widespread use of these strategies is recommended.

Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.

Therapeutic interventions in dementia. 2: Non-cognitive symptoms.

This is a two-part unit on therapeutic interventions in dementia, based on NICE and SCIE (2006) guidance. Part 1 outlined management strategies for cognitive symptoms and how to maintain function. This second part examines interventions for non-cognitive symptoms.