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Chronic disease self-management support for persons with dementia, in a clinical setting

Authors Ibrahim JE, Anderson LJ, MacPhail A, Lovell JJ, Davis M, Winbolt M

Received 6 September 2016

Accepted for publication 3 November 2016

Published 25 January 2017 Volume 2017:10 Pages 49—58


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Video abstract presented by Janaka Jonathan Lovell.

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Joseph Elias Ibrahim,1 Laura J Anderson,1 Aleece MacPhail,2 Janaka Jonathan Lovell,2 Marie-Claire Davis,1 Margaret Winbolt3

1Department of Forensic Medicine, Monash University, Southbank, 2Ballarat Health Services, Ballarat, 3Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia

Abstract: The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person’s ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient’s current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient’s skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.

Keywords: chronic disease, dementia, self-management, cognitive domains

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