Dr. Marina B. Wasilewski received her PhD from the Rehabilitation Sciences Institute at the University of Toronto. Dr. Wasilewski’s research interests include aging populations, sandwich generation caregivers, peer support, and online intervention delivery. Dr. Wasilewski has also championed the use of social media—specifically Twitter—in academic research and higher education
Dr. Margaret Saari is a nurse, researcher, educator and an inquisitive mind. Her research interests lie in the intersection of health systems, quality care, and outcomes. She passionately believes that interprofessional collaboration and open debate about where our healthcare system is headed is critical to improving quality. She is fully committed to continuous education and personal improvement.
Dementia Care Models: A Scoping Review
Background: As of 2016, there are half a million Canadians living with dementia. Additionally, each year, approximately 25,000 new cases are diagnosed. Given these staggering numbers, concern has been raised over the Canadian healthcare system’s ability to accommodate the needs of persons with dementia (PWD) and the associated costs of care. Models outlining the organization and delivery of dementia care will become increasingly important for supporting PWD and their families across the dementia trajectory. To date, most reviews have focused on dementia care models in the context of micro-level interventions and their impact on health outcomes. However, the development of a much-needed national dementia strategy will require a broader understanding of the macro-level philosophies and mid-level models that specify how care is best organized and delivered.
Objective: To identify and describe the underpinning philosophy, specific components, and overall goals of existing models of dementia care.
Methods: Arksey and O’Malley’s (2005) methodological framework for conducting scoping reviews was employed to structure this review. Searches were conducted in Medline, PsychINFO, Embase, CINAHL, and AGELINE for reviews published between Jan 1, 2007 and Oct 3, 2017.
Results: Manuscripts included in this review identified models spanning acute, community, and residential care sectors. The majority of models were underpinned by the principles of person-centered care. Broadly speaking, the models aimed to provide personalized care that met the unique needs of the PWD, maintained their autonomy, preserved personhood, and promoted quality of life. Models specific to the palliative and end-of-life settings emphasized the importance of understanding the person before the dementia diagnosis to provide care that is consistent with their life history and wishes. The models identified could be broadly categorized as focusing on environment/sensory modification, goal/activity-oriented practice, integration of healthcare services and personnel, and relationship optimization.
Conclusion: While many reviews focused on the same models, the description of components and goals varied between papers. Further, many papers described models that were in fact macro-level philosophies. A prominent example was the use of person-centered care models which were largely described in terms of beliefs and values but not operationalized with enough description to inform the practical organization and delivery of care. While palliative care models were reported, the majority focused on end-of-life care rather than informing care practices beginning at diagnosis. We recommend a framework where person-centered and palliative care act as overarching philosophies that guide the application of mid-level models across the PWD’s life course.