The Challenges of Providing Palliative Care for Older People with Dementia

Abstract

Palliative care seems the right approach to dementia, except that it suggests a dichotomy between cure and care. As in cancer care, supportive care provides a broader framework, viewing dementia from the time of diagnosis until death and bereavement. The challenge is to find the right approach to the individual. This challenge arises in the person's own home, in long-term care homes, and in hospitals. The challenging features of palliative care for older people with dementia are found in connection with the use of antibiotics, antipsychotics, and other medications, as well as in decisions about whether the person is in pain or in distress, or whether artificial feeding should be contemplated or not, as well as about the use of advance care plans. In short, the challenges are essentially ethical as well as clinical. The right approach will be the one that recognizes this facet of clinical care.

An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes

“…Commonly, families do not perceive dementia as a life limiting condition [ 23 , 24 ] and with-holding treatment can be morally and emotionally difficult [ 23 , 25 , 26 ]. Discussions on EOL care may highlight anticipatory grief for families who may feel they lack support [ 27 ]. Family carers may be ambivalent regarding what is an appropriate level of EOL treatment and many do not want to think about their relative’s death [ 28 , 29 ].…”

The burden of caring for people with dementia at the end of life in nursing homes: a postdeath study among nursing staff

“…Providing high quality end‐of‐life care for people with dementia living in nursing homes is highly challenging (Sachs et al ., ; Harris, ; Küpper & Hughes, ) and can therefore put high emotional and physical demands on caregivers. The World Health Organisation (WHO) considers dementia as a high priority public health issue and emphasises the importance of better care and more support to caregivers (Dementia a public health priority, WHO report, ).…”

The basis, ethics and provision of palliative care for dementia: A review

“…Questions of right and wrong or good and bad are never irrelevant to clinical practice. This is no more evident than in questions around palliative care for people with dementia [1]. Hence, whilst in the central section of our review we shall address questions to do with ethics directly, there are also ethical components to our consideration of both the rationale for and the provision of palliative care for people with dementia.…”