Primary Palliative Care in Dementia

Weisbrod, Neal

doi:10.1007/s13311-021-01171-x

Cited by 8 publications

(5 citation statements)

References 72 publications

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“…Palliative care is an integral part of high quality dementia care, ensuring communication about prognosis, discussions about disease progress, and comprehensive caregiver support. 50 Unsuccessful or absent communication between dementia caregivers and providers/teams can negatively impact a caregiver’s lack of understanding about the dementia diagnosis. In home-based palliative care, effective communication with healthcare professionals remains the most frequently reported unmet need among caregivers.…”

Section: Discussionmentioning

confidence: 99%

Improving Dementia Caregiver Activation With a Brief Communication Module

Wittenberg,

Sullivan,

Rios

2023

Am J Hosp Palliat Care

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Objective: Palliative care often plays a pivotal role in supporting informal caregivers of persons living with dementia who experience a lack of continuity in care. Dementia caregiver activation, the caregiver’s willingness and ability to navigate care needs, requires communication skills for developing relationships with healthcare providers. Communication activation is important because caregivers facilitate physician and patient information exchange. This study aimed to explore changes in communication outcomes (attitude, knowledge, and skills) and impact on caregiver communication activation (confidence, self-report) following completion of a brief communication module. Methods: A 15-minute asynchronous online module was developed to provide caregivers with communication skills for working with doctors and nurses. Caregivers completed pre/post module measures of communication outcomes, a vignette for applying communication strategies and were interviewed within a week of module completion to assess self-reported communication activation. Module acceptability was also evaluated. Results: Communication knowledge ( P < .01) significantly increased and nearly all participants (99%) demonstrated use of module-specific communication skills after completing the module. While not statistically significant, caregiver attitudes were in the expected direction. Caregiver self-reported communication confidence ( P < .001) significantly increased and 84% of caregivers described communication activation at post-module. Caregivers (83%) were likely to recommend the module. Conclusions: The brief communication module for dementia caregivers in this project offers an online resource with low time-burden that results in caregiver communication activation. Future testing in the clinical setting will increase understanding of its efficacy and integration and could be a viable resource for palliative care providers.

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Section: Discussionmentioning

confidence: 99%

Improving Dementia Caregiver Activation With a Brief Communication Module

Wittenberg,

Sullivan,

Rios

2023

Am J Hosp Palliat Care

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“…Una perspectiva similar es la que presenta Weisbrod (2022) quien menciona que es fundamental el papel de una evaluación precisa, para la toma de decisiones acertadas, la prescripción adecuada de medicamentos y el tratamiento eficaz del dolor. En este tanto plantea el autor que es claro que la demencia es particular, por cuanto presenta para el profesional en salud retos en continua evolución.…”

Section: Pág 706unclassified

Aproximación a la Intervención de la Demencia desde los Cuidados Paliativos

Cisneros Orozco,

De La O Diaz,

Mata Brenes

2024

Ciencia Latina

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This research explores dementia and its characteristics, along with an approach from the perspective of palliative care intervention. The theoretical framework is structured from the elements that characterize dementia, the differential diagnosis with respect to dementia whose origin is of another etiology, together with a general vision of palliative care and the intervention models that are developed from this. . The methodology used was a bibliographic review, focused on studies that had a close relationship with the topic under study and that also allowed us to have an updated vision of the topic. Among the discussion elements, the importance of having a holistic perspective in the treatment of the dementia patient is highlighted, which covers the clinical, emotional, social and spiritual aspects. Also, the importance of respect for the patient's autonomy is emphasized, this being a key aspect for the decisions that will be made in the therapeutic process.

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“…Where a decision to stop a cognitive enhancer has been made, the dose should be reduced gradually to avoid a withdrawal syndrome (typically involving neuropsychiatric symptoms like hallucinosis and delusions [ 91 , 92 ]). Relevant guidelines recommend that cognitive enhancers be reduced slowly and with close observation [ 33 , 91 , 93 ], for example reducing by 50% every 4 weeks until the medication can be removed at its lowest dose. If significant cognitive deterioration does occur post cognitive enhancer withdrawal, re-introducing the relevant medication at the lowest therapeutic dose could be considered.…”

Section: Discontinuing Cognitive Enhancersmentioning

confidence: 99%

Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults—a clinical review

et al. 2023

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Purpose Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate. Methods We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review. Results Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review. Conclusions The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.

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Primary Palliative Care in Dementia

Cited by 8 publications

References 72 publications

Improving Dementia Caregiver Activation With a Brief Communication Module

Improving Dementia Caregiver Activation With a Brief Communication Module

Aproximación a la Intervención de la Demencia desde los Cuidados Paliativos

Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults—a clinical review

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