Palliative care interventions in advanced dementia

Murphy, Edel; Froggatt, Katherine; Connolly, Sheelah; O’Shea, Eamon; Sampson, Elizabeth L; Casey, Dympna; Devane, Declan

doi:10.1002/14651858.cd011513

Cited by 39 publications

(55 citation statements)

References 35 publications

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“… 53 Increased collaboration between geriatric medicine, palliative care and psychiatry may be helpful but should be coordinated and supported by adequate resourcing and service commissioning. 54 Although the evidence base for interventions in dementia end-of-life care remains limited, 55 considering data used in our development of a complex intervention to improve care in advanced dementia, 20 we suggest a coordinated needs-based longitudinal approach should be developed and tested. 12 A recent survey found ‘hospice enabled care’ is an emerging model for palliative care for people with dementia in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life

et al. 2017

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Background:Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care.Aims:To describe (1) physical and psychological symptoms, (2) health and social care service utilisation and (3) care at end of life in people with advanced dementia.Design:9-month prospective cohort study.Setting and participants:Greater London, England, people with advanced dementia (Functional Assessment Staging Scale 6e and above) from 14 nursing homes or their own homes.Main outcome measures:At study entry and monthly: prescriptions, Charlson Comorbidity Index, pressure sore risk/severity (Waterlow Scale/Stirling Scale, respectively), acute medical events, pain (Pain Assessment in Advanced Dementia), neuropsychiatric symptoms (Neuropsychiatric Inventory), quality of life (Quality of Life in Late-Stage Dementia Scale), resource use (Resource Utilization in Dementia Questionnaire and Client Services Receipt Inventory), presence/type of advance care plans, interventions, mortality, place of death and comfort (Symptom Management at End of Life in Dementia Scale).Results:Of 159 potential participants, 85 were recruited (62% alive at end of follow-up). Pain (11% at rest, 61% on movement) and significant agitation (54%) were common and persistent. Aspiration, dyspnoea, septicaemia and pneumonia were more frequent in those who died. In total, 76% had ‘do not resuscitate’ statements, less than 40% advance care plans. Most received primary care visits, there was little input from geriatrics or mental health but contact with emergency paramedics was common.Conclusion:People with advanced dementia lived with distressing symptoms. Service provision was not tailored to their needs. Longitudinal multidisciplinary input could optimise symptom control and quality of life.

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Section: Discussionmentioning

confidence: 99%

Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life

et al. 2017

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“…Despite a growing evidence base on the role of social networks and social capital in healthcare, there is still significant emphasis on professionally enacted interventions 47 90 91 104. This emphasis is underpinned by a culture that seeks immediately recognisable outcomes of mutual benefit to care receivers and providers.…”

Section: Discussionmentioning

confidence: 99%

Social networks, social capital and end-of-life care for people with dementia: a realist review

et al. 2019

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Objectives(1) To develop an understanding of how social capital may be conceptualised within the context of end-of-life care and how it can influence outcomes for people with dementia and their families with specific reference to the context and mechanisms that explain observed outcomes. (2) To produce guidance for healthcare systems and researchers to better structure and design a public health approach to end-of-life care for people with dementia.DesignA realist review.Data sourcesMEDLINE, EMBASE, CINAHL and grey literature.AnalysisWe conceptualised social capital as a complex intervention and, in order to understand how change is generated, used realist evaluation methods to create different configurations of context, mechanism and outcomes. We conducted an iterative search focusing on social capital, social networks and end-of-life care in dementia. All study designs and outcomes were screened and analysed to elicit explanations for a range of outcomes identified. Explanations were consolidated into an overarching programme theory that drew on substantive theory from the social sciences and a public health approach to palliative care.ResultsWe identified 118 articles from 16 countries ranging from 1992 to 2018. A total of 40 context-mechanism-outcome configurations help explain how social capital may influence end-of-life care for people with dementia. Such influence was identified within five key areas. These included: (1) socially orientating a person with dementia following diagnosis; (2) transitions in the physical environment of care; (3) how the caregiving experience is viewed by those directly involved with it; (4) transition of a person with dementia into the fourth age; (5) the decision making processes underpinning such processes.ConclusionThis review contributes to the dispassionate understanding of how complex systems such as community and social capital might be viewed as a tool to improve end-of-life care for people with dementia.PROSPERO registration numberCRD42018084524.

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“…Structured aid for decision-making on feeding options 12 Advanced dementia in nursing homes/usual care.…”

Section: Very Lowmentioning

confidence: 99%

What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

et al. 2017

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BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies. RESUMO INTRODUÇÃO:Demência é uma condição com alta prevalência e incidência global. Sua característica crônica e progressiva tem impacto em aspectos físicos, psicossociais e na saúde pública. Nosso objetivo foi resumir evidências de revisões Cochrane sobre intervenções não farmacológicas para distúrbios cognitivos e demências. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas conduzida na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina, Universidade Federal de São Paulo. MÉTODOS: Foram incluídas revisões Cochrane sobre intervenções não farmacológicas para disfunções cognitivas e/ou qualquer tipo de demência, após a avaliação realizada de forma independente por dois autores. RESULTADOS: Vinte e quatro revisões foram incluídas. As revisões mostraram que ingestão de carboidratos e a terapia de validação podem ser benéficas para distúrbios cognitivos. Para demência, existe benefício potencial de programas de atividade física, treino cognitivo, tratamentos psicológicos, aromaterapia, terapia com luz, reabilitação cognitiva, estimulação cognitiva, oxigenoterapia hiperbárica associada a donepezila, análise funcional, terapia de reminiscência, estimulação elétrica transcutânea, decisão estruturada em op...

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Palliative care interventions in advanced dementia

Cited by 39 publications

References 35 publications

Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life

Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life

Social networks, social capital and end-of-life care for people with dementia: a realist review

What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

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