Palliative and end-of-life care for people living with dementia in rural areas: A scoping review

Abstract

Background and objectives People living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. Methods A collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis. Results All items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature. Conclusions Several areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended.

Dementia and Palliative Care: Sex Differences

“…Despite great advancements in technology, it is not often used in healthcare. This study further highlights three things that should be improved: general knowledge about dementia and the trajectory of the disease, making decisions about the end of life care at the beginning of the disease, having an individual approach [14]. Finally, it is important to provide a patient not only physical relief, but to take spiritual and psychosocial issues into consideration and help a patient maintain his dignity, which should be accentuated more in the future [6].…”

“…Studies showed there was a greater number of female participants as hospice recipients and hospice decedents with advanced dementia, but the reason for that could be longer female life span. Males were mostly associated with measures for prolonging life, and therefore more likely to get feeding tubes, while females were three times more likely to receive comfort care (symptom control and pain relief) [14,17,18] Findings emphasize the need for additional future research for sex-specific differences in advanced dementia.…”

Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review

“…In fact, many outcomes relating to this domain yielded inconsistent results. These inconsistencies were mentioned in a recent scoping review comparing palliative care in rural and urban PWD [ 92 ].…”

Developing Successful Palliative Care Teams in Rural Communities: A Facilitated Process

“…The need for PC in rural areas is increasing, including for specific conditions like cancer 22 and dementia. 23 Rural communities face unique challenges; those providing care are typically required to serve in several roles 24 and travel long distances. 24 , 25 Given that many community members lack awareness or understanding of what PC entails, 26 those providing care must also serve as educators in the community.…”