Advance Directives for Dementia

Gaster, Barak; Larson, Eric B.; Curtis, J. Randall

doi:10.1001/jama.2017.16473

Cited by 64 publications

(48 citation statements)

References 7 publications

(13 reference statements)

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“… 307 Therefore, advance care planning, designed to empower people with dementia and improve quality of dying, might theoretically be something everyone should do before developing dementia. 308 However, people might not be able to predict their future wishes. This might explain why family carer proxies show only low-to-moderate agreement with stated end-of-life treatment preferences of people with dementia.…”

Section: Interventions and Care In Dementiamentioning

confidence: 99%

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

et al. 2020

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Prof J Cohen-Mansfield), and Minerva Center for Interdisciplinary Study of End of Life (Prof J Cohen-Mansfield),should consider dementia in older people without known dementia who have frequent admissions or who develop delirium. Delirium is common in people with dementia and contributes to cognitive decline. In hospital, care including appropriate sensory stimulation, ensuring fluid intake, and avoiding infections might reduce delirium incidence.Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and thus society.

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Section: Interventions and Care In Dementiamentioning

confidence: 99%

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

et al. 2020

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“…Advance care planning was identified as crucial in preventing unnecessary hospitalisation in urgent situations, but can be a challenge to implement, as has been discussed in the wider end-of-life care literature. 77 Timely planning on what to do in urgent situations is advised to avoid problems of decision-making capacity, 78 but memory clinics and GPs have highlighted challenges of initiating these conversations when people are adjusting to living with their new diagnosis and capacity is not yet an issue. 79 80 Education of caregivers about how dementia progresses and the situations that may arise at end of life was highlighted as key in this review, as it has been in others.…”

Section: Discussionmentioning

confidence: 99%

Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

et al. 2020

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ObjectivesPeople with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.DesignScoping review. The search strategy and data synthesis were informed by people with dementia and carers.Data sourcesSearches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.Eligibility criteriaEmpirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.Data extraction and synthesisData were extracted using charting techniques and findings were synthesised according to content and themes.ResultsOf 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.ConclusionsThe scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.

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“…For excellent reports of advance directives in patients with dementia in the context of ethical and law issues, see Ref. ( 43 , 44 ). Clearly, defined clinical criteria indicating a time point for palliative care implementation might help to improve future treatment for advanced PD patients.…”

Section: Discussionmentioning

confidence: 99%

Impaired Quality of Life and Need for Palliative Care in a German Cohort of Advanced Parkinson’s Disease Patients

et al. 2018

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BackgroundParkinson’s disease (PD) is the second most frequent neurodegenerative disease of the elderly. Patients suffer from various motor and non-motor symptoms leading to reduced health-related quality of life (HRQOL) and an increased mortality. Their loss of autonomy due to dementia, psychosis, depression, motor impairments, falls, and swallowing deficits defines a phase when palliative care interventions might help to sustain or even improve quality of life.ObjectiveThe aim of this study was to investigate the current status of palliative care implementation and quality of life in a local cohort of advanced PD patients in order to frame and improve future care.Methods76 geriatric patients with advanced idiopathic PD meeting the inclusion criteria for palliative care interventions were clinically evaluated by neurological examination using Movement Disorders Society Unified Parkinson’s Disease Rating Scale, Barthel Index, Montreal Cognitive Assessment Test, and a structured interview concerning palliative care implementation.ResultsHRQOL is severely reduced in our cohort of geriatric advanced PD patients. We found motor deficits, impairment of activities of daily living, depression, and cognitive decline as most relevant factors determining decreased HRQOL. Only 2.6% of our patients reported present implementation of palliative care. By contrast, 72% of the patients indicated an unmet need for palliative care.ConclusionQuality of life is dramatically affected in advanced PD patients. However, we found palliative care to be implemented extremely rare in their treatment concept. Therefore, geriatric patients suffering from advanced PD should be enrolled for palliative care to provide adequate and holistic treatment which may improve or sustain their quality of life.

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Advance Directives for Dementia

Cited by 64 publications

References 7 publications

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences

Impaired Quality of Life and Need for Palliative Care in a German Cohort of Advanced Parkinson’s Disease Patients

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