Prognosis and planning
Improving dementia care includes advance care planning - the sharing of information on prognosis in order to engage persons with dementia, if they are willing and able, in the decisions that affect their care. It is an invitation to process dementia and consider what it might mean to have this diagnosis, and it requires an ability to comprehend ‘certain possibilities’ about one’s future (Sinclair et al., 2016). This chapter shows how psychoanalytically informed practice can improve the quality of advance care planning. When we prepare for a discussion on prognosis and planning, psychodynamic approaches help us avoid harm, appreciate the importance of structure, and guide us in making sense of the material that may emerge. This chapter explores some of the dynamic material that follows a dementia diagnosis and recognises the impact of dementia on personal narrative and the effect of wider social and relational factors on decision making. It suggests that acknowledging the traumatic effect of dementia allows us to deliver a more appropriate response.