Documentation as narrative continuity: A trauma-informed approach to preserving personhood in dementia care

People living with dementia may experience changes in memory, communication, and the ability to communicate preferences as the condition progresses, making continuity of knowledge across care relationships increasingly important. People living with dementia frequently have histories of psychological trauma, yet trauma-informed approaches within dementia care have largely focused on assessment, communication, and behavioural support rather than the role of clinical documentation. Clinical documentation plays a significant role in preserving information about a person's identity, history, values, relationships, preferences, and care needs, yet its role in supporting personhood and continuity of self has received comparatively limited attention. This commentary argues that documentation represents an overlooked ethical practice through which personhood, identity, and trauma-informed understanding are preserved or disrupted over time. This commentary introduces the concept of narrative continuity to describe the capacity of clinical documentation to support the ongoing interpretation of a person across clinicians, teams, and healthcare settings. We introduce the concept of narrative continuity to describe the role of clinical documentation in maintaining an individual's life history, values, relationships, and care needs as responsibility transitions across clinicians, teams, and healthcare settings. We distinguish clinical documentation as a form of professional reporting from narration, arguing that narrative continuity emerges through the interpretation of documented information by those who subsequently encounter the record. Trauma-informed documentation represents a specific application of this broader concept when trauma histories or trauma-related responses are relevant to care. As dementia progresses, individuals may experience reduced ability to communicate preferences, clarify misunderstandings, or challenge inaccurate representations within the medical record. Consequently, documentation increasingly becomes a significant source through which others interpret the person and respond to their needs. When records emphasize behavioural symptoms without contextual meaning, distress may be interpreted as a symptom of disease or pathology rather than as a response shaped by lived experience, increasing the risk of stigma and retraumatization. Conversely, trauma-informed documentation that preserves relevant contextual information about safety, preferences, communication, triggers, and supportive approaches can help clinicians understand behaviour within the context of the person's history and support individualized, person-centred care. We argue that documentation should be recognized not merely as an administrative requirement but as a communicative and ethical practice through which personhood and continuity of care can be supported across changing care relationships. Narrative continuity provides a framework for understanding how trauma-informed documentation may help preserve dignity, identity, autonomy, and continuity of self in dementia care.