Background People living with dementia have frequent encounters with ambulance services and have a high risk of mortality when admitted to hospital. The Mental Capacity Act and the National Institute for Health and Care Excellence (NICE) guidance provide a framework for all healthcare practitioners to support the person living with dementia into making their own healthcare decisions and encourages participation regardless of capacity status.
The purpose of this study was to understand if people living with dementia are afforded these opportunities to participate in healthcare decisions during interactions with paramedics and what key themes affect participation.
Methods Electronic database search of literature, based on keywords, of EBSCO (searching MEDLINE and CINAHL), hand-sifting, and grey literature.
Articles were searched for pre-hospital care, Paramedic, EMS, EMT but yielded few results and the terms Doctor, Nurse, Healthcare Professional were added to search matrix. Included articles focused on decision making, participation, were under 10 years old and UK based. 1 exception was made for a Norwegian study focusing on participation.
Articles were reviewed multiple times in a meta-synthesis to find themes within each article. Data was grouped, coded and categorised based on themes.
Results The findings illustrate that people living with dementia wish to retain autonomy and should be afforded the opportunity to participate in their own decision making regardless of capacity. Good and bad practice occurs, but many people living with dementia are marginalised, manipulated or have decisions taken from them.
Conclusion Paramedics need to engage with people living with dementia during all encounters regardless of the severity of the person’s dementia or capacity status. They need to take time to give the person every opportunity to participate, not be influenced by someone who is not the patient and aim to be more inclusive of the patient. Further primary research is required to fully understand the quality of interactions between paramedics and people with dementia.
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