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.pub2

Cited by 82 publications

(58 citation statements)

References 64 publications

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“…13 This is important given evidence that hospice improves quality of care of individuals dying with dementia, 26 although research is limited. 27 More than 40% of individuals had hospice initiated less than 1 month before death, limiting potential benefits and suggesting a need for better physician recognition of end-of-life symptoms in individuals with dementia. Prognostication and timely recognition of dying is one of 11 domains of optimal dementia palliative care.…”

Section: Discussionmentioning

confidence: 99%

Cause of Death and End‐of‐Life Experiences in Individuals with Dementia with Lewy Bodies

Armstrong

Alliance

Corsentino³

et al. 2018

J American Geriatrics Society

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Objectives To investigate the natural history, cause of death, and end‐of‐life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). Design Twenty‐question online survey administered through the Lewy Body Dementia Association. Setting United States. Participants Caregivers, family, and friends of individuals who died in the past 5 years with a diagnosis of DLB (survey respondents: n = 658, 89% female, median age 50–69). Measurements The survey included 3 questions about the respondent's background and 17 about the end‐of‐life experiences of the person with DLB. Topics included time from symptom onset and diagnosis to death, cause of death, advance directive completion, end‐of‐life education, hospice use, and location of death. Results were analyzed descriptively. Results Most individuals with DLB died within 5 years of diagnosis (median 3–4 years). Respondents indicated that physicians rarely discussed what to expect at the end of life (40% total, but only 22% to a helpful degree) and that the caregiver usually initiated such conversations. Death was usually expected, but fewer than half of respondents felt prepared for what to expect. Seventy‐eight percent used hospice, usually at home or in skilled care, with wide variations in duration. Failure to thrive was the most common cause of death (65%), followed by pneumonia and swallowing difficulties (23%), other medical conditions (19%), and complications from falling (10%) (multiple causes allowed). Conclusion Study results highlight a critical need for better prognostic counseling and education for persons and families living with DLB. The results of the current study can inform such counseling, but additional studies are needed to further explore expected prognosis of individuals diagnosed clinically with DLB and optimal use of palliative care services. J Am Geriatr Soc 67:67–73, 2019.

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Section: Discussionmentioning

confidence: 99%

Cause of Death and End‐of‐Life Experiences in Individuals with Dementia with Lewy Bodies

Armstrong

Alliance

Corsentino³

et al. 2018

J American Geriatrics Society

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“…Palliative care needs of older patients have been found to be different from those of younger ones [ 5 ], so we also need specific interventional studies addressing these needs. Up to now, however, the number of high-quality effectiveness studies in GPC is low [ 31 , 32 ]. Cluster randomized controlled trials are currently underway [ 33 ] and they intend to prove a similar level of effectiveness as already exists for palliative care in general [ 34 ].…”

Section: Theoretical Foundations and Concept Of Gpcmentioning

confidence: 99%

Geriatric palliative care: a view of its concept, challenges and strategies

et al. 2018

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In aging societies, the last phase of people’s lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both specialties have to collaborate closely and geriatric palliative care (GPC) should be conceptualized as an interdisciplinary field of care and research based on the synergies of the two and an ethics of care.Major challenges characterizing the emerging field of GPC concern (1) the development of methodologically creative and ethically sound research to promote evidence-based care and teaching; (2) the promotion of responsible care and treatment decision making in the face of multiple complicating factors related to decisional capacity, communication and behavioural problems, extended disease trajectories and complex social contexts; (3) the implementation of coordinated, continuous care despite the increasing fragmentation, sectorization and specialization in health care.Exemplary strategies to address these challenges are presented: (1) GPC research could be enhanced by specific funding programs, specific patient registries and anticipatory consent procedures; (2) treatment decision making can be significantly improved using advance care planning programs that include adequate decision aids, including those that address proxies of patient who have lost decisional capacity; (3) care coordination and continuity require multiple approaches, such as care transition programs, electronic solutions, and professionals who act as key integrators.

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“…In elderly participants, cancer, cerebrovascular diseases, dementia, cardiovascular diseases and chronic respiratory diseases are the main types of NCDs (Beaglehole et al, ; Ferlay et al, ). In the terminal stage of advanced NCDs beyond disease management, hospice care focusing on symptomatic control and comfort care is essential to sustain dignity and autonomy throughout the end‐of‐life course (Alwan, ; Murphy et al, ). A recent meta‐analysis found a positive relationship between hospice care interventions and the patients’ quality of life and symptom relief (Kavalieratos et al, ).…”

Section: Introductionmentioning

confidence: 99%

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

Huang

Kuo

et al. 2019

Health Soc Care Community

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The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.

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Palliative care interventions in advanced dementia

Cited by 82 publications

References 64 publications

Cause of Death and End‐of‐Life Experiences in Individuals with Dementia with Lewy Bodies

Cause of Death and End‐of‐Life Experiences in Individuals with Dementia with Lewy Bodies

Geriatric palliative care: a view of its concept, challenges and strategies

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

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