Understanding and reducing refusals of personal care in dementia

Background: Refusals of assistance with personal care in dementia can be a major source of distress for people living with dementia and their caregivers.

Aims: This article examines refusals of care and considers ways of minimising them.

Methods: Summary of factors related to refusals of care.

Findings: Refusals of care in dementia are common, can occur for many reasons, and can contribute to poor hygiene and caregiver burden. Safeguarding legislation is in place to help guide practitioners and person-centred care can be one way to help reduce and manage refusals. Charities and other organisations suggest multiple ideas to manage refusals. Research evidence for formal interventions is limited, with most evidence for music interventions, bathing modifications and communication techniques.

Conclusions: A holistic approach tailored to each person could prevent, reduce or manage refusals of care. Using non-pharmacological interventions and person-centred care, modifying the caregiver approach, adapting to the person’s preferences, minimising the care task, eliminating underlying issues and altering the environment may reduce the likelihood of refusals.