Case Study
Case Study 2: Mrs. Anjeela Johal Kaur
Anjeela Johal is 68 years old and has Alzheimer’s disease. Anjeela is a practicing Sikh and her religious
practices are important to her. Anjeela attends the Gurdwara, (temple) every week, accompanied by her
two sons, her daughters-in-law, and their children. Recently Anjeela attended a special celebration at
the Gurdwara with her family. At the end of the ceremony, one of her grand- children looked to where
Anjeela had been sitting and found that she was no longer there. Anjeela was found several yards away,
at the site of her previous home, looking for her husband who had died last year.
There have also been other instances, where Anjeela has become lost in familiar places and is now
developing mood swings where she varies from happy to angry and is difficult to manage. The family
have discussed Anjeela with the family G.P. and decided that she would be better cared for in a
residential setting. Anjeela has agreed to this but is unhappy about leaving her family home.
Anjeela has now moved to the Ashfold Residence where the staff are fully trained to support her.
The manager of the residence has met with Anjeela and her family to discuss the care and support
required to ensure that Anjeela still achieves a high quality of life. The family have informed the
manager of Anjeela’s dietary preferences, her interests, likes and dislikes. The family have also shared
some of Anjeela’s history including her marriage, her work as a teacher and medical conditions, she has
type 2 diabetes and an allergy to penicillin.
It has been agreed, that one of her sons will collect her on Sunday mornings and drive her to the
Gurdwara. It has also been agreed, that if no one in the family is available, due to holidays or illness,
then one of the staff will accompany Anjeela to ensure that she is able to follow her religious practices.
Anjeela was present at all planning stages and her opinions respected. She did become distracted and
forgetful in the sessions, and information gaps were filled by the family. Anjeela was informed about
decisions and appeared to be in agreement. The family have brought pictures from home to place on the
walls of Anjeela’s room in the residence and a CD player, so that she can listen to traditional music.
The residence celebrates all the major festivals from the major faiths and Anjeela was supported in
making and distributing food for tasting to the other residents during Diwali.
Anjeela has been provided with photographs of the family and her career as a teacher and loves to chat
to the other residents about the children she taught. She sometimes becomes confused and appears to
forget where she is. The staff remind Anjeela that she now lives in the residence, using her preferred
title of Mrs Johal Kaur.
Hannah
P5: Explain how person-centred care is applied for one individual who has one type of dementia
P6: Explain why a flexible approach is needed when planning care for one individual who has one type of dementia
(NHS, 2017) outline person-centred care as focusing the care on the needs of the individual, ensuring that their
preferences, wishes, needs and values guide clinical decisions, to provide care that is respectful and responsive to
them. As a result, they would have to take into consideration their individuality, behaviour, likes/dislikes and mobility.
Anjeela’s individuality was recognised during the planning stages to which she was present too, enabling her to input
her opinions and have her preferences heard. Consequently, the people planning would have to respect her decisions
and implement them into the plan, allowing her to express her individuality. Due to her Alzheimer’s, Anjeela has
started to develop mood swings, varying from happy to angry suddenly. This behaviour change can be difficult for
others to manage, and may also implicate her self-image as she can’t control her emotions. However, being in an
environment where staff are trained to handle these situations can be beneficial in providing a good standard of care
for Anjeela as they could be educated in how to effectively calm her down and prevent violent outbursts. Anjeela likes
to chat to others about her previous teaching career, traditional music and cooking food for the holidays, but doesn’t
like when she’s not referred to as Mrs Johal Kaur. These are important to include within the care plan as they can
influence the benefits of the person-centred principles, which will be expanded further down. Additionally, as her
disease progresses, she may lose part of her mobility, potentially making certain tasks dangerous. If these changes
were highlighted in the care plan, it can help with making adaptations to continuously meet her changing needs, whilst
ensuring safety and promoting independence.
Principles of person-centred care
Dignity, privacy and respect: Every individual should be entitled to this regardless of their condition, but
especially when they have Alzheimer’s as they are a changing person who may not be able to complain if the
standard of care they are receiving is poor. Anjeela’s religion should be respected by all staff members, even if
they have different religions or beliefs. They would have to ensure she was still able to follow her religious
practices and still be able to celebrate any holidays or foods that are a part of her religion. Furthermore, some
women in Sikhism don’t cut their hair. Consequently, if the staff members didn’t cut Anjeela’s hair, then it’d
, show respect and promote her wellbeing, as she is still following her religions practices, despite potentially not
remembering or realising it’s part of her beliefs. Dignity can be upheld by allowing an individual to choose
their outfits or making decisions towards their care. It can make them feel empowered as they’d be able to
make choices that they would have been able too before the disease. Privacy is also important as it can ensure
they can still have their own personal time and space. She would also have the right to exclude herself from
any activities or tasks that could go against her religion or even if she doesn’t want to participate. These all
promote health and wellbeing as Anjeela can still make her own choices and also continue to carry out her
religion, feeling accepted, staying safe and comfortable in her environment.
Independence, rights and empowerment: Revoking someone’s independence, rights and empowerment can
make them feel neglected and like a burden. It’s common that individuals with dementia are subjected to
abuse and neglect due to them being vulnerable. Vulnerability can stem from having a lack of independence
and being disempowered. Anjeela was present during her planning stages, meaning she could include her
preferences and requirements. This promotes her health and wellbeing because her opinions weren’t being
dismissed or refused. If she became distracted or forgetful then her family would fill in the gaps, but they still
provided her the opportunity to make her requirements known instead of her family taking over her care
completely. Staff should continue to encourage her to make choices even in the late stages of her dementia
because it can make her feel valued and included within her environment and society. Additionally, staff can
offer a person-centred approach by allowing Anjeela to continue any hobbies or interests she has, such as
cooking and listening to traditional music, as it’s part of her identity even before Alzheimer’s. It can encourage
independence because it can be something she can do alone as it’s personal to her, or she could choose to
share the experience with others. This can also link to allowing her to talk about her time as a teacher. Anjeela
may repeat the same story from when she was a teacher but if the staff members engage with her each time,
it can make Anjeela feel empowered as it’s a story close to her and would enjoy sharing it.
Recognition or cultural and religious requirements: If Anjeela wasn’t allowed to continue her religious
practices then it may result in her feeling detached and unaccepted. However, Ashfold Residence ensure that
she attends the Gurdwara every Sunday with her sons, and even if her family aren’t available, then a member
of staff would accompany her. This promotes health and well-being because it shows that the staff are being
sensitive to her religion and beliefs, making her feel comforted and respected. Furthermore, she’s supported
in distributing and making food for other residents during Diwali which is part of her religion. Additionally,
Sikhs diet would exclude eggs, fish and any ingredients with animal derivatives, meaning that they’re
vegetarians. This must be taken into account when preparing meals for Anjeela as it’s vital she is only given
food that is acceptable in her religion. While Anjeela ages, she may need a soft diet. Even if this happens, the
staff should continue to only allow Anjeela food that carries on her dietary requirements that correlate with
her religion. As her Alzheimer progresses, she may start to forget principles within her religion, meaning she
may not notice anything against her culture. This emphasises the importance of staff being aware of religious
requirements to ensure that they can still maintain their practices even when they no longer remember.
Entitlement to advocacy: An advocate is someone who speaks on behalf of another who may lack the capacity
to make reasoned judgments. These are important for someone who has dementia as it can allow their wishes
and preferences to be fulfilled and care needs met even if they’re not able to communicate these. Alzheimer’s
can affect an individuals ability to speak, forming a communication barrier. However, in a case like Anjeela’s,
her family may be able to become her advocate as they would be familiar with her religion and her later
wishes. They can also ensure that her needs are being continuously met, and if they believe they’re not, then
they could refer the concern or issue to a manager to be documented. Anjeela’s mental capacity may decline
but she would still have entitlements which an advocate can enable her to receive as they’d be speaking on
her behalf. Her needs aren’t just about her religion, but also her physical, intellectual, emotional and social
wellbeing, which can all be promoted through the use of an advocate.
Policies, procedures and regulations are enforced by legislation in order to maintain safety for the patient as well the
carer. It’s the carers responsibility to uphold and carry these out in order to protect them and others around them
from harm. Promoting rights and wellbeing enable a welcoming and safe environment for the service user to feel
comfortable in, making safeguarding very important in providing good quality of care. Acknowledging vulnerability and
continuously upholding the law is also important in maintaining safety, dignity and independence. Ways that Anjeela
can be kept safe through safeguarding can be for care workers to consider; protection versus independence and
rights, enabling/empowering environments, awareness of cultural and religious differences and lastly awareness of
representation and advocacy.
Protection versus independence and rights: There are training programmes in dementia care that allow care
workers to meet the service users needs and demands. However, due to dementia being a progressive
disease, their needs would be changing and they may develop or already have other illnesses that may
