The Clinical Course of Advanced Dementia

Genao, Liza; White, Heidi; Twersky, Jack

doi:10.1056/nejmc0911058

Cited by 5 publications

(1 citation statement)

References 36 publications

(44 reference statements)

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“…For example, although many would consider tube feeding a burdensome intervention for a nursing home resident with advanced dementia (as we did), federal nursing home regulations encourage interventions to prevent weight loss. 26 For the present study, we explored a compendium of potential outcome variables, and selected those we felt best represented a complete picture of the quality of end-of-life care for nursing home residents with advanced dementia. However, future work is needed to more extensively identify and validate quality measures and metrics for this population.…”

Section: Discussionmentioning

confidence: 99%

The Quality of Advanced Dementia Care in the Nursing Home

et al. 2012

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Background The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end-stage of this disease. Objective To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. Research Design This study employed longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. Results A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared to non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. Conclusions Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

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Section: Discussionmentioning

confidence: 99%

The Quality of Advanced Dementia Care in the Nursing Home

et al. 2012

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Current awareness in geriatric psychiatry

2010

Int J Geriat Psychiatry

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Reviews; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

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Multivariate Granger Causality Analysis of Acupuncture Effects in Mild Cognitive Impairment Patients: An fMRI Study

Chen

Bai

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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Evidence from clinical reports has indicated that acupuncture has a promising effect on mild cognitive impairment (MCI). However, it is still unknown that by what way acupuncture can modulate brain networks involving the MCI. In the current study, multivariate Granger causality analysis (mGCA) was adopted to compare the interregional effective connectivity of brain networks by varying needling depths (deep acupuncture, DA; superficial acupuncture, SA) and at different cognitive states, which were the MCI and healthy control (HC). Results from DA at KI3 in MCI showed that the dorsolateral prefrontal cortex and hippocampus emerged as central hubs and had significant causal influences with each other, but significant in HC for DA. Moreover, only several brain regions had remarkable causal interactions following SA in MCI and even few brain regions following SA in HC. Our results indicated that acupuncture at KI3 at different cognitive states and with varying needling depths may induce distinct reorganizations of effective connectivities of brain networks, and DA at KI3 in MCI can induce the strongest and more extensive effective connectivities related to the therapeutic effect of acupuncture in MCI. The study demonstrated the relatively functional specificity of acupuncture at KI3 in MCI, and needling depths play an important role in acupuncture treatments.

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The Clinical Course of Advanced Dementia

Abstract: Background-Dementia is a leading cause of death in the United States but is underrecognized as a terminal illness. The clinical course of nursing home residents with advanced dementia has not been well described.

Cited by 5 publications

References 36 publications

The Quality of Advanced Dementia Care in the Nursing Home

The Quality of Advanced Dementia Care in the Nursing Home

Current awareness in geriatric psychiatry

Multivariate Granger Causality Analysis of Acupuncture Effects in Mild Cognitive Impairment Patients: An fMRI Study

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