Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative.
This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such asPalliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by thePalliareproject supported through the Erasmus+ K2 Strategic Partnerships funding programme.
Alzheimer Scotland Centre for Policy and Practice, Hamilton, The University of the West of Scotland, ML3 0JB, UK.
Debbie
D
Tolson
Bishopbriggs, Glasgow, UK.
Anne
A
Fleming
Nationellt kompetenscentrum Anhöriga, Box 762, 391 27 Kalmar, Sweden.
Elizabeth
E
Hanson
Porto School of Nursing, Rua Dr Antonio Bernardino Almeida, Porto, Portugal.
Wilson
W
de Abreu
University of Alicante, Campus de San Vicente Raspeig s/n, Alicante, Spain.
Manuel Lillo
ML
Crespo
Alzheimer Scotland Centre for Policy and Practice, Hamilton, The University of the West of Scotland, ML3 0JB, UK.
Rhoda
R
Macrae
Alzheimer Scotland Centre for Policy and Practice, Hamilton, The University of the West of Scotland, ML3 0JB, UK.
Graham
G
Jackson
Faculty of Health Care Jesenice, Dean's Office, Spodnji Plavž 3, SI-4270 Jesenice, Slovenia.
Simona
S
Hvalič-Touzery
Gerontolgicke centrum, Simunkova 1600, 182 000 Praha 8 - Kobylisy, Czech Republic.
Iva
I
Holmerová
Turku University of Applied Sciences Ltd TUAS, Joukahaisenkatu 3A, Finland.
Pirkko
P
Routasalo
Prudent Healthcare; advanced dementia; integrated care; workforce