Palliative Care in Advanced Dementia

Feasibility and preliminary effectiveness of OLAIA multisensory program for people living with dementia

OLAIA is a multisensorial program designed to manage behavioural and psychological symptoms, based in their multidimensional aetiology, offering palliative support for people living with dementia. This study evaluated its feasibility, acceptability and preliminary effectiveness using a single group with a before-after design. Questionnaires included sociodemographic data, education level, cognitive functioning (GDS), pain and discomfort (PAINAD), agitated behaviours (CMAI) and satisfaction (post-intervention). Attendance, adverse events and satisfaction were recorded. Statistics included descriptives, Wilcoxon signed ranks and Mann-Whitney U test. Qualitative data were analyzed using thematic analysis. The attendance rate of the 64 participants was 59.4% and the retention rate was 92.2%. Results revealed positive satisfaction with the sessions and with the therapists, and a significant decrease in PAINAD at post-intervention (p<0.001). Four categories emerged in the qualitative analysis related to satisfaction, benefits, quality of the professionals, and recommendations for the future. The OLAIA was considered feasible, acceptable with promising preliminary effectiveness.

Palliative care for patients with advanced dementia

ABSTRACT

Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older adults globally. Its final stages are complicated by a multitude of problems that can cause immense suffering. This article explores the interconnection between advanced dementia and palliative care and the role of nurses in providing end-of-life care for these patients.

Los cuidados paliativos domiciliares reducen las consultas a urgencias y muertes en centros de salud a un menor costo

Resumen Objetivos Comparar los tipos de asistencia domiciliar geriátrica y paliativa para determinar cuál obtiene mejores resultados en los pacientes con demencia avanzada. Métodos El presente es un estudio de cohorte retrospectiva. Se incluyeron pacientes con demencia avanzada ingresados al programa de Atención Comunitaria Geriátrica de un hospital geriátrico público de Costa Rica en el periodo entre enero de 2018 y junio de 2019. Ellos se dividieron en dos grupos dependiendo del equipo especializado que realizó la atención domiciliaria y se analizaron sus características sociodemográficas y clínicas. Posteriormente, se analizaron los datos generados de los registros médicos sobre consultas de emergencia, hospitalización, lugar de defunción y costo de la visita generados por cada paciente entre junio de 2018 y diciembre de 2019. Se compararon 192 pacientes con demencia avanzada Global Dementia Scale 7 visitados por el equipo geriátricos especializado domiciliar con 19 de visitados por el equipo de cuidados paliativos especializado domiciliar del Hospital Geriátrico Nacional. Resultados Se analizaron 226 datos generados (192 por el programa de geriatría y 34 por el de paliativos). Los que recibían atención domiciliaria por un equipo paliativo tenían menos probabilidades de acudir a la sala de emergencias y morir en un centro de salud en comparación con aquellos que reciben atención domiciliaria por un equipo geriátrico, con un costo menor. Conclusiones El programa de cuidado paliativo especializado domiciliar reduce las consultas de emergencia, la muerte en el domicilio y los costos de atención en pacientes con demencia avanzada en comparación con el programa geriátrico.

Non-specialist palliative care: A principle-based concept analysis

BACKGROUND

Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as 'generalist', 'basic' and 'a palliative approach' are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted.

AIM

To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care.

DESIGN

The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care.

DATA SOURCES

The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken.

CONCLUSION

Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.

Palliative care for older people: the psychiatrist's role

In this overview we discuss the palliative psychiatric care of older people towards the end of life. We briefly consider ethics, dementia care, delirium, depression, anxiety, grief and physician-assisted suicide. We also discuss hope, dignity, spirituality and existentialism. We hope that this article will encourage clinicians to reflect on the effects of terminal illnesses on the mental health of dying people and the current provision of palliative psychiatric care.

LEARNING OBJECTIVES

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DECLARATION OF INTEREST

None.

Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.

Communication in dementia care

Dementia is a progressive neurodegenerative illness that affects a growing number of older adults in our country. We discuss ways to improve the management of persons with dementia within current healthcare models. Specifically, we argue that structured communication at regular intervals is essential for dementia care at all phases of illness. We emphasize the need for a single healthcare provider to take on a central role in organizing communication between patient, family and other healthcare providers in the outpatient setting. We also emphasize the need for healthcare providers to begin conversations about prognosis, care transitions and end of life early while balancing these difficult conversations with a hopeful attitude of realistic optimism that the disease can be managed.