Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.
BACKGROUND: The UK older population is becoming increasingly ethnically diverse, with a projected eight-fold increase in dementia among black, Asian and minority ethnic communities over the next 30 years, compared with a two-fold increase in white British people with dementia.
AIMS: This Admiral Nurse case study explores an understanding of culture and ethnic background in families' experiences of dementia and caring using a culturagram assessment framework.
FINDINGS: The culturagram enabled a more comprehensive assessment, so that care delivery was sensitive to the specific cultural and ethnicity issues in a relationship-centred approach to dementia care.
CONCLUSION: An understanding of the cultural influences in light of a diagnosis of dementia were essential in developing a care package that met the needs of all family members.