Dementia is the leading cause of death in older Australians, and people with dementia often experience distressing symptoms and burdensome interventions at the end of life. Dementia Australia estimates that 1.6 million Australians are involved in the care of someone with dementia. Despite this, people living with and dying from dementia are less likely to access palliative care. One reason for this is that traditional models of palliative care, arising from the care of people with cancer, do not meet the needs of people with dementia, due to a prolonged disease trajectory associated with a gradual loss of function over a number of years. The WA Department of Health Churchill Fellowship allowed me to visit multiple clinical, research and community organisations in six countries (USA, the Netherlands, Belgium, UK, Ireland, Singapore) in 2022, to explore models of palliative care for people with dementia. This presentation will describe various models of palliative dementia care and outline several common components of these models that may be adapted to Australian settings, such as: care navigation, screening for palliative care needs, monitoring outcomes, care navigation and public health measures.

Presentation Theme: Models of care – implications for the future

Background: Many people who live in residential aged care facilities (RACFs) have moderate-to-severe cognitive impairment, and most people with advanced dementia live in RAC. Optimal palliative care for people living with advanced dementia, as reflected in Aged Care Quality Standards, prioritises person-centred care and quality-of-life. Person-centred approaches that include individually-tailored non-pharmacological interventions have been shown to reduce agitation and anxiety, and use fewer medications to manage behaviours with lower risk of adverse events. Laughter Care is a non-pharmacological, psychosocial intervention delivered by trained practitioners (Elder Clowns). Evidence for efficacy of Laughter Care in residents with dementia is growing, yet limited.

 

Aim: To explore strategies used by Laughter Care practitioners in interactions with residents with dementia in residential aged care to inform future research and distill approaches that can be used by residential aged care staff. 

 

Methods: Laughter Care practitioners from The Humour Foundation were purposively recruited to participate in in-depth semi-structured interviews. Eight interviews were audio-recorded, transcribed, and thematically analysed.

 

Results: Engagement techniques were varied and tailored to individual residents and contexts, yet, overarching strategies to facilitate engagement centred on valuing personhood, reminiscence, and creating connection.  Elder clowns act as confidantes and facilitators of community for residents.  Their ‘reading of the room’ informs whether to engage through gentle persistence, indirect approaches, and when appropriate, to create space for humour, silliness, and laughter and play. Elder Clowns also engaged in interactions that were gentle, quiet, and supportive, particularly when residents had advanced dementia or were approaching end-of-life. 

 

Conclusions: Laughter Care practitioners are highly skilled, sensitive, and adaptable communicators who engage with residents with dementia and demonstrate capacity to provide comfort and support in palliation and at end-of-life. Identified approaches will contribute to progressing the evidence base and facilitate RACF staff training in interaction and communication strategies.

Presentation Themes: Quality palliative care for diverse populations, both for consumers and service providers

This panel discussion will bring together a wealth of experience from the aged care sector. Our panellists will discuss the challenges of providing quality palliative care for the ageing population in Australia, including integrating palliative care into different aged care settings, the importance of a holistic approach to palliative care and difficulties of developing and maintaining a workforce trained in palliative care.