Evidence and Practice

Clinical

Risk management and decision-making in dementia care

Why you should read this article: • To better understand the areas of risk that may become apparent across the life course of dementia • To recognise the ethical issues posed by trying to eliminate the risk of harm for people living with dementia • To consider how the principles of safeguarding apply to risk management in dementia care What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management.

Using therapeutic lies – an ethical challenge for nurses when caring for people with dementia

Using therapeutic lies – an ethical challenge for nurses

White lies' can be useful when caring for people with dementia, but is it ethical to use them?

Exploring whether a diagnosis of severe frailty prompts advance care planning and end of life care conversations

Severe frailty diagnosis: advance care planning and end of life care conversations

People with severe frailty may be disadvantaged in terms of receiving appropriate end of life care

Exploring the professional nurse advocate role and restorative clinical supervision

Exploring the professional nurse advocate role and restorative clinical supervision

The role aims to provide clinical, educational and well-being support to nurses

Supporting shared decision-making in medicines use with people living with dementia and their carers

Supporting shared decision-making in medicines use with people living with dementia

Shared decision-making may help support people to make informed decisions about their treatment

Open access
Equipping the healthcare workforce to meet the complex health needs of older people in the community: a skills-led approach

Equipping the healthcare workforce to meet the needs of older people in the community

Explore the benefits of a versatile, multiskilled workforce for the wider healthcare system

CPD articles

Exercise as a falls prevention strategy in the care of older people

Exercise as a falls prevention strategy in the care of older people

Nurses should motivate older people to exercise and adopt exercise-based falls prevention strategies

Identifying incontinence and promoting continence in people living with dementia

Identifying incontinence and promoting continence in people living with dementia

Practical strategies that can support people living with dementia and their family carers

Benefits of deprescribing for older people with frailty and polypharmacy: part two

Benefits of deprescribing for older people with frailty and polypharmacy: part two

Nurses should be aware of tools that may assist in preventing or reducing inappropriate medicines use

Benefits of deprescribing for older people with frailty and polypharmacy: part one

Benefits of deprescribing for older people living with frailty and polypharmacy: part 1

Adverse effects of polypharmacy on older people and medicines optimisation for those living with frailty

Recognising, reducing and preventing deconditioning in hospitalised older people

Recognising, reducing and preventing deconditioning in hospitalised older people

How nurses can help older people in hospital regain their mobility

Open access
Improving nutrition and hydration in older people with dementia in care homes

Improving nutrition and hydration in older people with dementia in care homes

Person-centred interventions to improve food and drink intake of older people with dementia

How to

Hearing loss

How to address the communication needs of older patients with hearing loss

Hearing loss is a common problem in older people and may have a negative effect on their care while in hospital, as well as resulting in significant cost to the NHS. This article outlines the findings of a two-year project in an NHS trust to improve the care of older people with hearing loss. An important outcome of the project was the development of a hearing loss toolkit containing good practice recommendations and tools to help staff in all NHS trusts, and other care settings, implement practical and cost-effective improvements.

Planning

How to use advance care planning in a care home

Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.

Practice question

An older woman in hospital sits on her bed and a nurse has brought a walking frame to encourage her to move, as this will help manage deconditioning syndrome

How can you identify and respond to deconditioning in an older person?

Nurses can encourage older people in acute hospitals to be more active

An older woman turns to a nurse and smiles during a falls assessment that involves holding lengths of tape fastened to wall bars

What does a comprehensive geriatric assessment involve?

It can help you provide person-centred support for older people living with frailty

Illustration of diversity with the heads of a multicultural crowd of people

How should nurses promote equality, diversity and inclusion?

All health and social care staff should commit to being champions of these values at work

Illustration of a head in profile that is cracked and has autumn leaves tumbling out to illustrate delirium and dementia

What is the difference between delirium and dementia?

A collateral history is crucial in distinguishing between the conditions

Why is measurement of lying and standing blood pressure vital in falls risk assessment?

A blood pressure drop on standing is more prevalent in those with comorbidities and frailty

How can person-centred strategies improve dementia care?

An empathetic approach to care can help people with dementia retain a sense of self

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