Palliative care for people with dementia: a literature review

Abstract

With growing numbers of people dying with, and from, dementia there is a need for professionals and health-care organisations to review the access to and provision of palliative care. This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; undertreatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making.

The Role of Palliative Care in the Management of Patients with Advanced Hepatocellular Carcinoma: A Single Institution Experience

“…in patients with less than 1-2 weeks of life) that impairs their remainder survival as well as their quality of life [18]. It is the undoubted right of patients and their caregivers to be informed about such situations [18][19][20]. The present study also clearly demonstrates the strong association of previous HBV as well as HCV infections with the subsequent development of HCC (95% association).…”

“…There are scenarios in which insisting on adequate nutrition becomes an unnecessary burden (e.g. in patients with less than 1-2 weeks of life) that impairs their remainder survival as well as their quality of life [18]. It is the undoubted right of patients and their caregivers to be informed about such situations [18][19][20].…”

Controlo Sintomático nos Doentes em Fim de Vida

“…13 Several studies have attempted to identify prognostic indicators or indexes that inform when a palliative care approach should be initiated. 14,15 The CARING criteria (C = cancer; A = admissions ≥ 2 in the last year; R = residence in a nursing home; I = intensive care unit admit with multiple organ failure; NG = ≥ 2 criteria for admission to noncancer hospice) assesses the risk of death one year after a patient is admitted to a hospital. 13 A simple approach, widely used as an indicator of eligibility for palliative care, is called the 'surprise question' ('Would you be surprised if your patient died within the next 12 months?…”

“…In particular, the need for hospitalization due to respiratory or urinary tract infection should alert a physician to the possibility of imminent death in patients with advanced dementia syndrome. 14,15 When a patient begins to agonize, clinical criteria such as breathing pattern changes, altered state of consciousness (delirium), increased asthenia, skin colour changes and loss of ability/interest in eating and drinking can be identified.…”

Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia

“…In the later stages of the disease and towards the end of life, symptoms like depression, apathy, and agitation are common, as are physical issues like dysphagia, incontinence, myoclonus, and seizures (Hugo and Ganguli, 2014). However, people with dementia are less likely to be referred to palliative care teams; they are prescribed fewer palliative care medications; they are unlikely to be assessed for existential needs before death; and they often lack adequate pain relief (Lillyman and Bruce, 2016). Dementia ultimately leads to a need for palliative care to mitigate symptoms that are physical and existential, and according to Hermans et al (2017), one of the many challenges in the provision of care is to relieve palliative symptoms that people with dementia may experience at the end of their life.…”