Human capabilities in advanced dementia: Nussbaum's approach

Area of Science:

• Gerontology
• Bioethics
• Philosophy of Care

Background:

• Supporting individuals with advanced dementia who exhibit challenging behaviors presents difficulties in meeting their needs and ensuring a dignified existence.
• Problematic behaviors in advanced dementia can stem from unmet needs and hinder the pursuit of a dignified life.

Purpose of the Study:

• To investigate the applicability of Martha Nussbaum's human capabilities approach to promoting dignity for individuals with advanced dementia residing in nursing homes.
• To identify how the capability approach can inform care practices for advanced dementia patients experiencing behavioral challenges.

Main Methods:

• An ethnographic methodology incorporating participatory observation was employed.
• Martha Nussbaum's capability approach served as the analytical framework.
• Data were collected from four women with advanced dementia and problematic behaviors in a Swedish nursing home during 2015.

Main Results:

• Individuals with advanced dementia struggled with life planning and the human capability of practical reasoning.
• Social exclusion risked hindering the human capability of affiliation for these individuals.
• Dignified living for advanced dementia patients necessitates nursing staff presence and tailored support to facilitate human capabilities.

Conclusions:

• Fostering opportunities for practical reasoning and affiliation is paramount, as these capabilities underpin all others.
• Care must extend beyond basic needs to encompass other capabilities vital for a dignified life, guided by Nussbaum's capability approach.
• Attending to expressions and needs, and guiding individuals towards dignity, are essential components of care for advanced dementia patients.