Review of Programs for Persons Facing Death with Dementia

Abstract

Background: Persons with advanced dementia cannot initiate activities because of the executive dysfunction. The lack of activities was identified as one of the most important factors contributing to behavioral problems of these persons. The unmet needs were boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activities. There is a need for activities designed specifically for residents with advanced dementia. Objective: A description of patient’s needs and of programs that intend to maintain quality of life for people with dementia and facing death. Data sources: A literature review of programs used for persons with advanced dementia and residing in long-term facilities, using the PubMed data base and collateral sources. Results: Since palliative care is appropriate for persons with advanced dementia, attention has to be paid to three following important aspects of care: Medical issues, behavioral symptoms, and meaningful activities. Medical interventions should be limited to those which have more benefits than burdens, behavioral symptoms should be distinguished according to the context in which they occur, and treated by non-pharmacological interventions that involve meaningful activities. This review describes four programs that may promote the quality of life in persons with advanced dementia and facing death. They are designed for persons with advanced dementia, taking into account their functional impairments. Most of these programs involve short infrequent sessions. In contrast, Namaste Care is a daily extended program of enhanced nursing care that can provide quality of life until the last breath. Conclusions: It is possible to maintain quality life for people with advanced dementia if a special program of activities is available.

Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy

“…Accordingly, our study provides empirical evidence regarding the heterogeneity of BPSD [ 13 - 15 ] by revealing the distinct underlying predictors for the seven BPSD subsyndromes. Results showed that there were multiple predictors of all BPSD; however, the mechanisms underlying how a set of neurobiological, psychosocial, and environmental factors interplay and subsequently result in specific symptoms remain elusive [ 72 ].…”

“…Although BPSD are associated with neurological mechanisms of neurocognitive disease to some extent, previous studies have revealed that the actual occurrence of symptoms can be attributed to diverse personal factors (eg, medical conditions, premorbid personality, and physical and psychological unmet needs), social factors (eg, communication with caregivers, caregivers' stress and depression, and lack of social activities), and environmental factors (eg, overstimulation and lack of established routines), rather than to neurocognitive impairment alone [11,12]. While a few studies have provided evidence that supports frequent co-occurrence of individual BPSD, others have contended that BPSD are distinct and heterogeneous and have different determinants and consequences [13][14][15]. Determining key factors that predict the different types of BPSD is the first step, since it would guide the determination of which strategies should be chosen to target the underlying causes and ultimately prevent or manage the symptoms [12,16,17].…”

Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy (Preprint)

“…Accordingly, our study provides empirical evidence regarding the heterogeneity of BPSD [13][14][15] by revealing the distinct underlying predictors for the seven BPSD subsyndromes. Results showed that there were multiple predictors of all BPSD; however, the mechanisms underlying how a set of neurobiological, psychosocial, and environmental factors interplay and subsequently result in specific symptoms remain elusive [72].…”

Stimulating sense memories for people living with dementia using the Namaste Care programme: What works, how and why?

“…Finding ways to connect, communicate and engage people living with dementia to mitigate the symptoms of advancing cognitive decline is crucial for quality of life (Volicer, 2019). Caregivers and families are also impacted by dementia (Allen et al, 2020).…”