Biologic personhood in advanced dementia: An integrative review to guide ethical and evidence-based care in long-term care settings.

This integrative review synthesizes evidence on biologic care interventions for individuals with advanced dementia in long-term care settings. Biologic personhood, as defined by Buron¹, affirms that individuals remain sentient and emotionally expressive even when words and memory are lost, making this dimension of care essential as cognitive and communicative abilities decline. Guided by Whittemore and Knafl's² integrative review methodology, this study synthesized 28 peer-reviewed studies published between 2010 and 2025 examining biologic care interventions. Interventions were categorized into five domains: comfort and symptom relief, functional and sensory support, restorative rhythms of daily life, communication and attunement, and environmental safety and autonomy. Across studies, biologic interventions reduce distress, improve comfort, and affirm personhood through relational presence and attuned response. Several studies reframed behaviors often labeled as disruptive into signals of unmet needs requiring understanding rather than control. Despite its clinical and ethical importance, biologic personhood remains systemically underrepresented in person-centered care frameworks that typically emphasize autonomy or memory-based identity. This manuscript, the first in a three-part series, argues that biologic care is foundational to sustaining dignity and comfort when the narrative self is inaccessible. By grounding care in presence, sensation, and attuned nonverbal connection, clinicians uphold human dignity and demonstrate that personhood endures even when language and memory do not.