DESK REVIEWS | 04.03.05. (How) does the policy encourage person-centred care?

DESK REVIEW | 04.03.05. (How) does the policy encourage person-centred care?

Yes. Nowadays, the care pathway in Brazil focuses on older people’s multidimensional assessment in the context of healthy ageing. Healthcare is not only centred on the absence of disease, but is focused on the maintenance of independence, avoidance of functional capacity loss, and promotion of good quality of life (Brazilian Ministry of Health, 2018e).

References:

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

 

The dedicatory of the plan presents a recommendation for a humanistic, compassionate, person-centred, and quality-of-care approach; however, this concept is not developed throughout the full text.

Not applicable as there is no dementia-specific policy or plan for South Africa.

At policy level, yes. Community healthcare agents and primary healthcare staff should conduct a multidimensional assessment and, from that, identify what the person is able to do independently and what help is needed. This is part of the integral care for older people, that considers clinical, psychosocial, and functional aspects of a person’s life. As one of the aims of the multidimensional assessment is to keep people’s independence, it is expected that support regarding the maintenance of an active role in the community is provided. It is important to state that all older persons can receive education regarding the maintenance of an active role in the community, regardless of having dementia (Brazilian Ministry of Health, 2018e).

References:

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

The national strategic plan aims to ensure that older people stay healthy and productive and therefore can continue to support the nation’s social system and economy. This is encouraged through a life-cycle perspective, which emphasises prevention by encouraging and supporting people in reducing risks of dementia to maintain healthy and active brains (Ministry of Health Republic of Indonesia, 2015b). Indicator 1.9 in the fourth action step, outlines the aim that an increased proportion of older people with physical or cognitive limitations should still be able to take part in physical, social, and spiritual activities (Ministry of Health Republic of Indonesia, 2015b). However, this seems to support the underlying aim of diagnosing more people at an earlier stage, as the plan does not describe in detail people with dementia could be supported in maintaining an active role in the community as the disease progresses.

References:

Ministry of Health Republic of Indonesia. (2015b). National Strategy: Management of Alzheimer and Other Dementia Diseases: Towards Healthy and Productive Older Persons. Ministry of Health Republic of Indonesia.

An active role of the people with dementia is not mentioned in the plan.

Not applicable as there is no dementia-specific policy or plan for South Africa.

Probably yes (policy level), but there is no evidence that this occurs in practice. Not only people living with dementia, but older people in general as part of the multidimensional assessment which aims to keep people clinically, psychosocially, and functionally independent (Brazilian Ministry of Health, 2018e).

References:

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

 

Although not explicitly stated, this is mainly addressed in the fourth action step (early diagnosis and management). These are the indicators which support people with dementia in maintaining self-management:

  • Indicator 1.5 all referral facilities should have neurorestoration service (rehabilitation based on neuroscience principles). This serves as a mean to help the person with dementia maintain their independence.
  • Indicators 1.6 and 1.7 refer to the increased number and quality of day care and home care services. This will support people who are no longer in good health and need assistance in staying active and in performing daily activities of living.
  • Indicator 1.9 increased proportion of older people with disability (physical or cognitive) who can continue participating in physical, social, and spiritual activities. This serves as a secondary prevention effort.
  • Indicators 2.1 and 2.2 refer to the presence of a guideline on dementia care and training for caregivers (Ministry of Health Republic of Indonesia, 2015b).
References:

Ministry of Health Republic of Indonesia. (2015b). National Strategy: Management of Alzheimer and Other Dementia Diseases: Towards Healthy and Productive Older Persons. Ministry of Health Republic of Indonesia.

 

There’s no special emphasis on it.

Not applicable as there is no dementia-specific policy or plan for South Africa.

This should happen (stated in policy), but there is no evidence that this occurs in practice. Not only people living with dementia, but all older people, as part of the integral healthcare orientation document and the multidimensional assessment for older people (Brazilian Ministry of Health, 2018e). However, we could not find information about how many older adults on average have this assessment completed routinely throughout the country, nor there is information about how this is managed when the person with dementia can no longer express his/her wishes. There is not a clear guidance about how this should be done, so it depends on the willingness of the clinician involved in the care provided.

References:

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

 

The national dementia policy has not discussed this issue explicitly (Ministry of Health Republic of Indonesia, 2015b).

References:

Ministry of Health Republic of Indonesia. (2015b). National Strategy: Management of Alzheimer and Other Dementia Diseases: Towards Healthy and Productive Older Persons. Ministry of Health Republic of Indonesia.

It is not specifically mentioned in the document.

Not applicable as there is no dementia-specific policy or plan for South Africa.