Dentists' Approaches to Treatment Decision-Making for People with Dementia: A Qualitative Study.

INTRODUCTION: Globally, the number of people living with dementia (PLwD) is projected to increase substantially. Dentists will encounter an increasing number of PLwD retaining natural teeth who need dental care. Dental treatment planning can be complex for PLwD as both oral diseases and dental treatment can be detrimental to patients' oral and social function and comfort. In addition, patients may lack the capacity to make decisions about their treatment, posing further challenges for dentists. OBJECTIVE: This study aimed to explore dentists' approach to treatment decision-making with or for PLwD. METHODS: Semistructured one-to-one interviews were completed with 22 dentists between April 2020 and March 2021. Data generation and analysis followed the principles of constructivist grounded theory with data being collected and analyzed simultaneously using a maximum variation sample. Interviews were recorded, transcribed verbatim, and then analyzed, leading to a theoretical understanding of how dentists approach treatment decisions for PLwD. RESULTS: Four data categories describe dentists' approaches to treatment decision-making for PLwD. Dentists sought to provide individualized care for PLwD. However, they described planning care based on risk-benefit analyses that primarily considered biomedical factors and generic assumptions. There was an underemphasis on the psychological or social implications of dental care or its delivery. Furthermore, while some dentists attempted to involve patients in treatment decisions, they reported fewer attempts to identify the views and preferences of PLwD identified as lacking decisional capacity. In this scenario, dentists reported leading the decision-making process with little regard for patients' known or identified preferences and minimal involvement of PLwD's family. CONCLUSIONS: Dentists acknowledge the complexity in treatment decision-making for PLwD yet focused heavily on biomedical considerations, with an underemphasis on individuals' preferences and autonomy. Considering psychosocial aspects of care alongside biomedical factors is essential to support holistic person-centered care for this growing patient cohort. KNOWLEDGE TRANSFER STATEMENT: This study highlighted that dentists may only be considering biomedical aspects of care when considering what treatment is appropriate for people living with dementia. When making or supporting treatment decisions, dentists should explore patients' preferences and actively consider relevant psychosocial factors. These can be actively identified through considered discussions with patients as well as their family members. Gathering this information should support more person-centered and value-concordant decision-making for people living with dementia.

Investigating what works to support family carers of people with dementia: a rapid realist review.

Introduction: Advances in longevity and medicine mean that many more people in the UK survive life-threatening diseases but are instead susceptible to life-limiting diseases such as dementia. Within the next 10 years those affected by dementia in the UK is set to rise to over 1 million, making reliance on family care of people with dementia (PWD) essential. A central challenge is how to improve family carer support to offset the demands made by dementia care which can jeopardise carers' own health. This review investigates 'what works to support family carers of PWD'. Methods: Rapid realist review of a comprehensive range of databases. Results: Five key themes emerged: (1) extending social assets, (2) strengthening key psychological resources, (3) maintaining physical health status, (4) safeguarding quality of life and (5) ensuring timely availability of key external resources. It is hypothesized that these five factors combine and interact to provide critical biopsychosocial and service support that bolsters carer 'resilience' and supports the maintenance and sustenance of family care of PWD. Conclusions: 'Resilience-building' is central to 'what works to support family carers of PWD'. The resulting model and Programme Theories respond to the burgeoning need for a coherent approach to carer support.

Teaching elderly patients how to use inhalers. A study to evaluate an education programme on inhaler technique, for elderly patients.

Elderly patients often receive little or no teaching on the use of their inhalers. This study evaluated a patient teaching programme, designed specifically for elderly people. The sample (n = 27) was taken from patients who were prescribed inhalers and had been admitted to the elderly care wards of an acute provider unit. Individual inhaler technique was assessed, using a simple checklist, both before and after teaching and total scores calculated. Each subject received one to one teaching sessions by a registered nurse on four consecutive occasions that inhaled medication was due, together with an information sheet on inhaler technique. Total scores showed significant improvement; however, improvement on any one action was not found to be significant. Thus patient teaching leads to a significant improvement in inhaler technique; however, further research is necessary to determine whether this improvement is sustained over time. Recommendations for practice are made.

Developing standards of care to meet older patients' needs.

This article describes an assessment of the needs of older people in order to develop standards of care and a competencies matrix. The nurses involved in the initiative attempted to define the knowledge, skills and attitudes required to deliver a quality service, and identify which of these could be used to enhance their own professional development.

Learning to live with Parkinson's. A teaching programme to boost patient understanding.

As Parkinson's disease becomes increasingly prevalent among elderly people, it is important sufferers understand both their symptoms and how their medication works. A teaching programme can help them manage the disease effectively.