Watch Over Me©: Therapeutic Conversations in Advanced Dementia

Abstract

“Watch over me” is a framework and strategies that clinicians can use in providing practical support and counseling to patients with dementia and their families. This framework is intended to address the needs and experiences of simultaneous trajectories of illness experienced by people with dementia and their family caregivers. These experiences can be described through the stages of dementia for the person with the disease and corresponding stages in the family’s journey. Each individual’s and family’s experiences are unique, yet these intentionally simplified schemas provide a context through which to address predictable problems and decisions regarding matters of physical health, living situation and caregiver needs and well being.Watch Over Me builds on trust between each patient and his or her caregivers, including the person’s chosen proxy decision-makers. It also builds on and fosters trust between a patient and family and the patient’s doctor. Watch Over Me brings the trusting, covenantal values within loving relationships into the processes of planning and caring. This approach complements and balances the contractual values that are protective or defensive and are embedded in medical ethics and advance directives.Communication with patients and families living with dementia is sometimes difficult and may be uncomfortable for physicians and other professional health care providers, yet it is always valued by patients and families and very often helpful in clarifying people’s perspective and priorities, thereby informing current plans of care. This presentation will offer practical therapeutic communication strategies to facilitate advance care planning conversations with patients and families as a person with dementia progresses to advanced