Integration of a Palliative Approach in the Care of Older Adults with Dementia in Primary Care Settings: A Scoping Review

Abstract

A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.

Dementia care and prevention in community settings: a built environment framework for cognitive health promotion

“…Age and dementia-friendly processes were a common focus, including clinical partnerships [57 ▪▪ ,58 ▪▪ ,59,60 ▪ ], caregiving support and patient navigation [61 ▪ ,62 ▪ ]. They included ethical, financial, and infrastructural aspects of care [63 ▪▪ ,64 ▪ ,65 ▪▪ ,66 ▪▪ ,67,68]. To illustrate, Fishleder et al [57 ▪▪ ] developed a measure of clinical-community linkages with input from 38 community staff.…”

Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada

“…The length of time analyses for both sites also pointed to an average of 2 years as an important marker for remaining in the community before discharge to LTC or becoming deceased. There lies the window of opportunity for home care to potentially change the characteristics of a client’s path, through effective approaches such as restorative care/therapy services [ 65 – 68 ], targeted service for individuals with cognitive impairment [ 7 , 69 – 72 ], disease management and stabilization [ 73 ], and services and supports (e.g., primary care integration) [ 3 , 74 – 76 ] to slow disease progression [ 77 ]. Access to home care at earlier stages of need may also be beneficial [ 15 ].…”

Implementing Palliative Care Teams Specialized in Dementia in Two Countries: Experiences of Failure and Success

“…Specialized residential dementia pal-32 liative care has been introduced in the 1980 s in the 33 US [2][3][4]. However, other than such residential, or 34 advance care planning programs, few services based 35 on the current, growing evidence base on the spe-36 cific needs in dementia at the end of life have been described and evaluated [5,6]. Possibly, evaluations of less successful models remain unpublished while…”