The Namaste Care™ program for people with dementia at end of life in residential aged care services

An article written by Dr Sara Karacsony, University of Tasmania

More than half (54%) of aged care residents have some form of dementia with those in the more advanced stages no longer able to participate in usual leisure or memory care activities. Their families may stop visiting because they can no longer communicate or know what they can do to support them. Most of their time is spent sleeping in bed or a chair or in the activity room as an activity is taking place that they cannot participate in. If they do not exhibit agitation, people with advanced dementia are at risk of becoming silent and invisible. Currently, few interventions specifically target people living with advanced dementia as their disease progresses, even though the lack of tailored interventions contribute to behavioural problems, sensory deprivation, social isolation and loneliness. [1]

It is recognised that people with advanced dementia suffer serious symptom burden at end of life (EOL) that could be avoided with quality palliative care. Their palliative care needs are similar to EOL cancer care (pain and symptom management, declining mobility, dysphagia, and psychological distress). [2, 3]

A specialised program to improve the quality of life for people with advanced dementia, until the end of life, was identified as a gap in care practices. [1, 4] The importance of a calm environment and sensory-based care promotes comfort, and also offers a way for families to remain connected in the care of their loved one.

What is Namaste Care?

The Namaste Care Program™, is a structured, person-centred program that provides tailored, multi-sensory activities aimed at improving quality of life for people in the advanced stages of dementia. The Namaste Care group program takes place in an environment as free from distractions as possible. Activities of daily living are offered using a slow, unhurried loving touch approach.

Namaste Care stimulates a person’s senses to promote comfort and pleasure. Faces are gently washed and moisturised.  Hair is gently combed or brushed.  Hands and arms are moisturised.  These activities are provided by the Namaste Carers to each person in the program. 

The Namaste Care room is prepared in advance with attention paid to creating a calm, relaxing and welcoming environment. Gentle and relaxing sounds or music are used to create an atmosphere rather than provide entertainment. Natural aromas or aromatherapy diffusers create pleasant smells and visual images including photos or pictures are used for reminiscence. Residents are offered drinks and nutritious tasty snacks that help stimulate appetite and increase food intake and hydration. Pain assessments are undertaken to ensure the person is pain-free throughout the program. While residents may not remember what they have done during Namaste Care, they experience a calming effect, such that sleep patterns appear to improve, they are more likely to eat and drink, and are less prone to agitation and distress.

The foundation of any program is an idea, a philosophy. The Namaste Care philosophy emphasises that the person with advanced dementia still lives even when they can no longer say who they are or what their lives have been. The positive effects of the program can be seen in their eyes, sometimes in their smiles and positive responses to interactions that are provided through the senses. This is the spirit that lives beyond the disease and which the ‘Namaste’ care program seeks to promote.

In Australia there has been limited uptake of the Namaste Care program despite international evidence of its effectiveness to the person with dementia, their family carers and aged care staff. [5-7]. A team from the University of Tasmania’s College of Health and Medicine have now evaluated aged care staff knowledge, attitudes and perceived skills and competence following dementia education and training in the Namaste Care program that shows benefits to staff  and sets facilities up for success for when the program is implemented. [8, 9]

We have also been successful in securing funding through the Aged Care Research and Industry Innovation (ARIIA) grants to implement Namaste Care programs in residential aged care services in Tasmania. The research findings should support Namaste Care as a vehicle for improved palliative care for the projected 173,500 people living with dementia who will enter residential aged care in the next 30 years.

Recommended further reading

Simard J. The end-of-life Namaste Care program for people with dementia. 3rd ed. Baltimore, Maryland: Health Professions Press; 2022.

Author

Dr Sara Karacsony

Senior Lecturer, School of Nursing

Graduate Research & Adjunct Coordinator, University of Tasmania

Reference

1. Volicer L. Review of programs for persons facing death with dementia. Healthcare (Basel). 2019 Apr 15;7(2):62.
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3. Thuné-Boyle ICV, Sampson EL, Jones L, King M, Lee DR, Blanchard MR. Challenges to improving end of life care of people with advanced dementia in the UK. Dementia. 2010;9(2):259-284.
4. Simard J. Namaste, giving life to the end of life. Alzheimer's Care Quarterly. 2005;6(1):14-19.
5. Froggatt K, Best A, Bunn F, Burnside G, Coast J, Dunleavy L, et al. A group intervention to improve quality of life for people with advanced dementia living in care homes: The Namaste feasibility cluster RCT. Health Technol Assess. 2020;24(6):1-140.
6. Tasseron-Dries PEM, Smaling HJA, Doncker SMMM, Achterberg WP, Van Der Steen JT. Family involvement in the Namaste Care family program for dementia: A qualitative study on experiences of family, nursing home staff, and volunteers. Int J Nurs Stud. 2021;121:103968.
7. Smaling HJA, Francke AL, Achterberg WP, Joling KJ, van der Steen JT. The perceived impact of the Namaste Care family program on nursing home residents with dementia, staff, and family caregivers: A qualitative study. J Palliat Care. 2022:08258597221129739.
8. Karacsony S, Abela MR, Eccleston C. ‘There's something they can do’: Educating aged care staff about the trajectory of dementia, palliative care and the Namaste Care™ program: A mixed methods study. Australas J Ageing. 2023.