How to Deliver a Person-Centered Alzheimer’s or Dementia Diagnosis
At the foundation of person-centered care for dementia are three core elements: maintaining relationships, honoring the patient’s uniqueness and staying present in the moment. Each of these elements is central to Brookdale’s Alzheimer’s and dementia care program and services, and each element is also important for the pivotal moment when a clinician first delivers the news of a dementia diagnosis.
If you’re unsure of how to handle this conversation with your patient, you’re not alone. Even though primary care providers are on the front lines in providing dementia care, a 2020 report from the Alzheimer’s Association found that as many as 82% said they’re not confident in dementia care or diagnosis. Approximately 1 in 5 primary care physicians had no residency training in dementia, and nearly 2 in 5 report they are “never” or only “sometimes” comfortable making a diagnosis of Alzheimer’s or other forms of dementia.
To help, Brookdale memory care experts have outlined how to have a person-centered conversation that can help your patients and those who love them live their best life with dementia.
Build On an Established Clinical Relationship
The frequency of diagnosis and treatment of Alzheimer’s or dementia in the primary care setting has increased in recent years due to updated guidelines and increased availability of diagnostic tools. Sharing the diagnosis with the patient may be a conversation better suited for the primary care provider than a specialist because of their personal history with the patient and the patient’s family. Remember to involve care partners in this conversation about steps they can proactively take to manage their loved one’s diagnosis as well as support their own health. But be thoughtful to always include the person with the diagnosis in the conversation, especially when discussing their diagnosis, symptoms, care plan or future. It’s best to frame this conversation around building a partnership to manage the condition together.
There’s a strong correlation between a primary care provider’s involvement and patients’ being diagnosed at an earlier stage of the disease. That additional time is critical, since it not only may allow for greater mitigation of the disease’s progression, but patients can also be more personally involved in their care and long-term planning. Research also shows that non-physician care providers in residential care settings can help increase detection of dementia and prompt earlier diagnoses, which speaks to the value of care coordination and building strong relationships between long-term care settings and primary care providers.
Tailor the Diagnosis Delivery to the Individual
Especially because dementia — and its progression — varies from person to person, there are individual factors to consider in regard to delivering a person-centered diagnosis of dementia, such as educational, cultural or clinical considerations. A patient may prefer not to know their diagnosis; or a provider may determine the patient doesn’t have the capacity for this news, depending on the stage of their condition or other health issues. But even in these scenarios, experts agree that clarifying that there is a problem is an important aspect of delivering this diagnosis.
Establishing realistic expectations for treatment — in particular, acknowledging that slowing the disease, not curing it, is the only possible course of action at this time — is imperative to managing emotional responses. First, it’s important to educate the patient and family about the stage of the disease they’re in, with the previously mentioned personal sensitivities in mind. Their current state is unlikely to improve, but it’s important to acknowledge the cognitive and physical functioning that remains — which can potentially be preserved through medication and psychosocial interventions to improve quality of life. These interventions are central to Alzheimer’s and dementia care at Brookdale.
Be Present for This Patient, in This Moment
While delivering diagnoses and establishing care plans are clinical processes, person-centered care prioritizes paying attention to the dynamics of the unique conversation happening in the moment. A supportive tone and positive delivery can help someone processing this diagnosis start their journey with a healthier outlook, while internalized stigma or pessimism from a provider’s experience with previous cases can negatively affect the patient’s outcomes. It is important to check your own biases prior to the conversation.
Counter the emotional distress or despair that’s likely to occur by focusing on the life that’s still possible while accommodating limitations of Alzheimer’s disease. Especially if it was caught early, encourage patients in all the steps that can be taken to try to mitigate its progression. Living a full, engaged and healthy life are all part of managing the progression of this illness, as well as a patient’s emotional resilience to living with it.
Ultimately, It Should be a Series of Conversations
The diagnosis of dementia of any kind is emotionally and physically complex. The guidelines have expanded beyond memory loss to include other cognitive issues around impaired reasoning, vision or spatial judgment, and finding the right words. That’s why it’s essential to spread out this conversation over stages that cover the physical causes of the disease and the treatments that are available to help slow its progression, as well as to check in on the patient’s emotional and physical state after the initial diagnosis.
At Brookdale, we are here not only for our residents, but for their family members and care team members too. To learn more, check out the resources at the National Council of Dementia Minds website. If you have any further questions about Brookdale’s person-centered approach to memory care, contact a Brookdale representative today.
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