Comorbid Dementia and Cancer in Residents of Nursing Homes

Blytt, Kjersti Marie; Selbæk, Geir; Drageset, Jorunn; Natvig, Gerd Karin; Husebø, Bettina S.

doi:10.1097/ncc.0000000000000478

Cited by 20 publications

(30 citation statements)

References 43 publications

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“…Although the use of palliative care improved quality of death in patients with dementia, reduced quality of death in patients with dementia might reflect the challenges of providing care for cancer patients with dementia. Previous research showed that cancer patients with dementia displayed more agitation, apathy and sleep disturbances than those without dementia, and also indicated that cancer patients with dementia were given sedatives instead of necessary pain treatment . In the present study, pain was significantly associated with quality of life by the univariate analysis.…”

Section: Discussionsupporting

confidence: 59%

“…Previous research showed that cancer patients with dementia displayed more agitation, apathy and sleep disturbances than those without dementia, and also indicated that cancer patients with dementia were given sedatives instead of necessary pain treatment. 23 In the present study, pain was significantly associated with quality of life by the univariate analysis. Pain is not only one of the most frequently encountered symptoms among patients with advanced illnesses, such as dementia and cancer, but it is also associated with lower quality of life.…”

Section: Discussionsupporting

confidence: 48%

“…Consent to participate was indicated by completion of the questionnaire. This study was approved by the Tokyo Metropolitan Institute of Medical Science (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Methodsmentioning

confidence: 99%

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Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka

Nakanishi

Fukahori

et al. 2020

Geriatrics Gerontology Int

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Aim The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end‐of‐life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer‐related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end‐of‐life care discussions with patients and their families, along with developing specific support strategies to enhance the decision‐making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 48%

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Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka

Nakanishi

Fukahori

et al. 2020

Geriatrics Gerontology Int

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“…Nursing home residents have complex physical and mental health problems, and are often prescribed numerous of medications [1,2]. In Norway, more than 80% of nursing home residents have mild to severe cognitive impairments [3,4]. It is acknowledged that polypharmacy often leads to medication-related problems (MRPs), and is further associated with hospitalizations, morbidity, mortality, and a decline in quality of life [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

2019

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Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied.

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“…Approximately 46.8 million people worldwide suffer from dementia – a number estimated to reach 131.5 million by 2050 ( Prince et al, 2016 ). In nursing homes (NH), 50–80% of patients have dementia ( Helvik et al, 2015 ; Blytt et al, 2017b ), a neurodegenerative condition that results in the decline of physical and cognitive functions ( Cricco et al, 2001 ). Sleep disturbances are common among NH patients with dementia, with prevalence ranging from 24.5% ( Moran et al, 2005 ) to 60% ( Neikrug and Ancoli-Israel, 2010 ; Ownby et al, 2014 ; Peter-Derex et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Pain Treatment Did Not Improve Sleep in Nursing Home Patients with Comorbid Dementia and Depression: A 13-Week Randomized Placebo-Controlled Trial

et al. 2018

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Objective: Previous research indicates that pain treatment may improve sleep among nursing home patients. We aimed to investigate the long-term effect of pain treatment on 24-h sleep patterns in patients with comorbid depression and dementia.Design: A 13-week, multicenter, parallel-group, double-blind, placebo-controlled randomized clinical trial conducted between August 2014 and September 2016.Setting: Long-term patients from 47 nursing homes in Norway.Participants: We included 106 patients with comorbid dementia and depression according to the Mini Mental Status Examination (MMSE) and the Cornell Scale for Depression in Dementia (CSDD).Intervention: Patients who were not using analgesics were randomized to receive either paracetamol (3 g/day) or placebo tablets. Those who already received pain treatment were randomized to buprenorphine transdermal system (maximum 10 μg/h/7 days) or placebo transdermal patches.Measurements: Sleep was assessed continuously for 7 days by actigraphy, at baseline and in week 13. Total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), early morning awakening (EMA), and number of wake bouts (NoW) were evaluated. In addition, daytime total sleep time (DTS) was estimated. Pain was assessed with Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2).Results: The linear mixed model analyses for TST, SE, SOL, WASO, EMA, NoW and DTS showed no statistically significant differences between patients who received active pain treatment and those who received placebo. Post hoc subgroup analyses showed that there were no statistically significant differences between active treatment and placebo from baseline to week 13 in patients who were in pain (MOBID-2 ≥ 3) at baseline, or in patients who had poor sleep (defined as SE < 85%) at baseline. Patients who received active buprenorphine showed an increase in TST and SE compared to those who received active paracetamol.Conclusion: The main analyses showed that long-term pain treatment did not improve sleep as measured with actigraphy. Compared to paracetamol, TST and SE increased among patients who received buprenorphine. This could indicate that some patients had beneficial effects from the most potent pain treatment. However, based on the present findings, long-term pain treatment is not recommended as a strategy to improve sleep. Clinical Trial https://clinicaltrials.gov/ct2/show/NCT02267057.

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Comorbid Dementia and Cancer in Residents of Nursing Homes

Cited by 20 publications

References 43 publications

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

Long-Term Pain Treatment Did Not Improve Sleep in Nursing Home Patients with Comorbid Dementia and Depression: A 13-Week Randomized Placebo-Controlled Trial

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