When life is lived with dignity and decline: integration of rehabilitation and palliation in dementia care - a case report.

Abstract

Background: The loss of meaning in life often underpins a desire to die, while rediscovering purpose and forming relationships can restore the will to live. This pursuit of meaning and the ability to express one's identity are central to both rehabilitation and palliative care. This case report examines the integration of these care principles within the framework of "Omsorg," a Danish word and concept of care rooted in genuine acts of kindness, as implemented at Dagmarsminde, a nursing home for residents with moderate to severe dementia.

Case presentation: Kirsten, an 86-year-old woman with advanced dementia, moved to Dagmarsminde in 2020. Upon arrival, she retained some mobility but exhibited limited facial expressions and impaired language. Her care plan emphasized deprescription, authentic surroundings, and "Omsorg," fostering engagement and reducing reliance on pharmaceuticals. This integrated approach combined rehabilitation to improve her physical skills and independence with palliative care to support her search for meaning and dignity in daily life. Following a pelvic fracture in 2023, Kirsten underwent tailored rehabilitation, regaining her ability to walk before her condition deteriorated due to dementia progression. In her final stages, Dagmarsminde prioritized dignity and comfort, employing minimal doses of opioids and benzodiazepines to alleviate suffering. Kirsten passed away peacefully in November 2024, surrounded by her family.

Conclusions: Dagmarsminde's holistic care philosophy integrates rehabilitation, palliative care, and "Omsorg" to empower residents in expressing their identity and engaging in a meaningful community. By prioritizing authenticity, individualized care, and acts of kindness, this approach fosters dignity and well-being throughout life and in its final stages. The case of Kirsten highlights the profound impact of personalized care in affirming an individual's significance, even amid the cognitive and physical challenges of dementia.