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Küppers L, Ritz-Timme S, Hartung B. [Died from or with dementia? The relationship between dementia and cause of death]. Dtsch Med Wochenschr 2021; 146:677-682. [PMID: 33957690 DOI: 10.1055/a-1380-1436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Specifying a singular specific cause of death or an appropriate causal chain in the death certificate can be challenging, especially in cases of elderly, multimorbid deceased persons.The German cause of death statistics suggest that mental illnesses, including dementia, are beneath the most frequent causes of death. But when looking at death certificates in the context of dementia considerable information gaps and a lack of plausibility in the causal chain can be observed quite regularly.In this article we give recommendations for the correct designation of the cause of death and underlying diseases in the death certificate. These recommendations are not only to be seen against an academic background. The correct registration of dementia in the causes of death statistics may be a basis for decision making in health politics and is hence in the interest of optimal patient care.
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Affiliation(s)
- Lisa Küppers
- Institut für Rechtsmedizin, Universitätsklinikum Düsseldorf, Düsseldorf
| | | | - Benno Hartung
- Institut für Rechtsmedizin, Universitätsklinikum Düsseldorf, Düsseldorf
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2
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Abstract
The number of people with dementia and delirium not induced by alcohol and other psychoactive substances has significantly increased during the last decades and will rise further in the future, particularly in the oldest old. In the vast majority of cases dementia is characterized by a progressive course with shortened life expectancy and a lack of curative treatment options. Delirium will remit in many cases; however, in a substantial proportion of patients the further course is unfavorable. Life expectancy is greatly reduced in these patients, mostly in association with advanced dementia and age-related multimorbidity. Intensified inclusion of palliative medical care aspects in the planning of treatment is indicated in the context of advanced and incurable conditions associated with a presumably clearly reduced life expectancy. The aim is to achieve the best possible relief of distressing somatic and psychiatric symptoms for the sake of the patients and their families. The competencies of psychiatry and palliative care can complement each other in this respect. In addition, there is a need for healthcare policy measures beyond the associated interdisciplinary opportunities and challenges in order to establish the necessary healthcare structures.
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Diehl-Schmid J, Hartmann J, Roßmeier C, Riedl L, Förstl H, Egert-Schwender S, Kehl V, Schneider-Schelte H, Jox RJ. IssuEs in Palliative care for people in advanced and terminal stages of Young-onset and Late-Onset dementia in GErmany (EPYLOGE): the study protocol. BMC Psychiatry 2018; 18:271. [PMID: 30170575 PMCID: PMC6119330 DOI: 10.1186/s12888-018-1846-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scientific research on palliative care in dementia is still underdeveloped. In particular, there are no research studies at all on palliative care issues in young onset dementia (YOD), although significant differences compared to late onset dementia (LOD) are expected. Most studies have focused on persons with dementia in long term care (LTC) facilities but have neglected persons that are cared for at home. We hypothesize that unmet care needs exist in advanced and terminal stages of YOD and LOD and that they differ between YOD and LOD. METHODS/DESIGN The EPYLOGE-study (IssuEs in Palliative care for people in advanced and terminal stages of Young-onset and Late-Onset dementia in GErmany) aims to prospectively assess and survey 200 persons with YOD and LOD in advanced stages who are cared for in LTC facilities and at home. Furthermore, EPYLOGE aims to investigate the circumstances of death of 100 persons with YOD and LOD. This includes 1) describing symptoms and management, health care utilization, palliative care provision, quality of life and death, elements of advance care planning, family caregivers' needs and satisfaction; 2) comparing YOD and LOD regarding these factors; 3) developing expert-consensus recommendations derived from the study results for the improvement and implementation of strategies and interventions for palliative care provision; 4) and communicating the recommendations nationally and internationally in order to improve and adapt guidelines, to change current practice and to give a basis and perspectives for future research projects. The results will also be communicated to patients and their families in order to counsel and support them in their decision making processes and their dialogue with professional caregivers and physicians. DISCUSSION EPYLOGE is the first study in Germany that assesses palliative care and end-of-life issues in dementia. Furthermore, it is the first study internationally that focuses on the specific palliative care situation of persons with YOD and their families. EPYLOGE serves as a basis for the improvement of palliative care in dementia. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov ( NCT03364179 ; Registered: 6. December 2017.
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Affiliation(s)
- Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675, Munich, Germany.
| | - Julia Hartmann
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Carola Roßmeier
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Lina Riedl
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Hans Förstl
- 0000000123222966grid.6936.aDepartment of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str.22, 81675 Munich, Germany
| | - Silvia Egert-Schwender
- 0000000123222966grid.6936.aMünchner Studienzentrum, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- 0000000123222966grid.6936.aInstitute for Medical Informatics, Statistics and Epidemiology of Technical University of Munich, Munich, Germany
| | | | - Ralf J. Jox
- 0000 0004 1936 973Xgrid.5252.0Institute of Ethics, History, and Theory of Medicine, Ludwig Maximilians Universität, Munich, Germany ,0000 0001 0423 4662grid.8515.9Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Diehl-Schmid J, Riedl L, Rüsing U, Hartmann J, Bertok M, Levin C, Hamann J, Arcand M, Lorenzl S, Feddersen B, Jox RJ. [Provision of palliative care for people with advanced dementia]. DER NERVENARZT 2018; 89:524-529. [PMID: 29327100 DOI: 10.1007/s00115-017-0468-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As a result of a literature-based expert process, this review provides an overview about the principles of palliative care for people with advanced dementia that are relevant for clinical practice. In particular, the indications, impact and aims of palliative care for advanced dementia are described. Life-prolonging measures and management of symptoms at the end of life are discussed. Furthermore, the overview focuses on the legal basis of decision making.
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Affiliation(s)
- J Diehl-Schmid
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - L Riedl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | | | - J Hartmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Bertok
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Levin
- Institut für Allgemeinmedizin, Technische Universität München, München, Deutschland
| | - J Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Arcand
- Department of Family Medicine, University of Sherbrooke, Quebec, Kanada
| | - S Lorenzl
- Krankenhaus Agatharied, Agatharied, Deutschland
| | - B Feddersen
- Klinik und Poliklinik für Palliativmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - R J Jox
- Geriatric Palliative Care, Lausanne University Hospital, Lausanne, Schweiz.,Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
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Koppitz A, Bosshard G, Blanc G, Hediger H, Payne S, Volken T. Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention. BMC Palliat Care 2017; 16:27. [PMID: 28431539 PMCID: PMC5399861 DOI: 10.1186/s12904-017-0200-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home. METHODS A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents. DISCUSSION The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of "total pain" for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself. TRIAL REGISTRATION Registration trial number: DRKS00009726 on DRKS, registered 10 January 2017, retrorespectively registered. Clearance certificate is available of the ethics committees of the canton of Thurgau, Switzerland, number: TG K201-02, and Zurich, Switzerland, number: ZH 01-2016.
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Affiliation(s)
- Andrea Koppitz
- Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Technikumstrasse 81, 8401, Winterthur, Switzerland.
| | - Georg Bosshard
- University Hospital Zurich, Clinic for Geriatric Medicine and Centre on Aging and Mobility at the University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Geneviève Blanc
- Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Technikumstrasse 81, 8401, Winterthur, Switzerland
| | - Hannele Hediger
- Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Technikumstrasse 81, 8401, Winterthur, Switzerland
| | - Sheila Payne
- Lancaster University, International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster, LA1 4YG, UK
| | - Thomas Volken
- Zurich University of Applied Sciences, School of Health Professions, Institute of health science, Technikumstrasse 81, 8401, Winterthur, Switzerland
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Koppitz A, Bosshard G, Kipfer S, Imhof L. Decision-making in caring for people with dementia at the end of life in nursing homes. Int J Palliat Nurs 2016; 22:68-75. [DOI: 10.12968/ijpn.2016.22.2.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Koppitz
- Deputy Head of Nursing Research and Development, Institute of Nursing, Zurich University of Applied Sciences, Switzerland
| | - Georg Bosshard
- Long Term Care Physician, University Hospital of Zurich, Clinic for Geriatric Medicine, and Centre on Ageing and Mobility, University of Zurich
| | - Stephanie Kipfer
- Research Associate, Haute École De Santé, Health Department, Fribourg, Switzerland
| | - Lorenz Imhof
- Head of Nursing Research and Development, Institute of Nursing, Zurich University of Applied Sciences
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Nehen HG, Hermann DM. Supporting dementia patients and their caregivers in daily life challenges: review of physical, cognitive and psychosocial intervention studies. Eur J Neurol 2014; 22:246-52, e19-20. [PMID: 25104513 DOI: 10.1111/ene.12535] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/26/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is associated with multiple daily life challenges that have a major impact for health outcome, affecting both the patients and their caregivers. In this review, the efficacy of physical, cognitive and psychosocial interventions in the treatment of dementia patients is evaluated, and how caregiver education and support may contribute to patient care is analysed. RESULTS AND CONCLUSIONS Due to the complex nature of cognitive and psychosocial interventions, their efficacy depends strongly on local settings. Thus, active components of these interventions are not always obvious, even in controlled randomized trials. Successful patient management includes (i) the safekeeping of basic support, (ii) the provision of a stable external milieu that is adjusted to the patients' cognitive resources and (iii) the provision of multimodal therapeutic concepts that are closely adapted to the practical needs of the patients and caregivers.
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Affiliation(s)
- H-G Nehen
- Department of Geriatrics, Elisabeth Hospital Essen, Essen, Germany
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Gather J, Vollmann J. Physician-assisted suicide of patients with dementia. A medical ethical analysis with a special focus on patient autonomy. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:444-453. [PMID: 23850340 DOI: 10.1016/j.ijlp.2013.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For many years there has been a controversial international debate on physician-assisted suicide (PAS). While proponents of PAS regularly refer to the unbearable suffering and the right of self-determination of incurably ill patients, critics often warn about the diverse risks of abuse. In our article, we aim to present ethical arguments for and against PAS for patients in an early stage of dementia. Our focus shall be on ethical questions of autonomy, conceptual and empirical findings on competence and the assessment of mental capacity to make health care decisions. While the capacity to make health care decisions represents an ethically significant precondition for PAS, it becomes more and more impaired in the course of the dementia process. We present conditions that should be met in order to ethically justify PAS for patients with dementia. From both a psychiatric and an ethical perspective, a thorough differential diagnosis and an adequate medical and psychosocial support for patients with dementia considering PAS and their relatives should be guaranteed. If, after due deliberation, the patient still wishes assistance with suicide, a transparent and documented assessment of competence should be conducted by a professional psychiatrist.
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Affiliation(s)
- Jakov Gather
- Department of Psychiatry, LWL University Hospital, Ruhr-University Bochum, Germany.
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Pinzon LCE, Claus M, Perrar KM, Zepf KI, Letzel S, Weber M. Dying with dementia: symptom burden, quality of care, and place of death. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:195-202. [PMID: 23589742 DOI: 10.3238/arztebl.2013.0195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND No detailed information has been available until now about the care setting, circumstances and place of death, symptom burden, and quality of care of persons with end-stage dementia in Germany. METHODS This cross-sectional study is based on a random sample of 5000 persons who died in the period from 25 May to 24 August 2008 in the German federal state of Rhineland-Palatinate. Their surviving relatives were contacted and asked to participate in a questionnaire survey. Data were obtained in this way for 310 persons with dementia and 931 persons without dementia. RESULTS 42.4% of the persons with dementia died at home. Most patients and their relatives preferred death at home to death anywhere else (94.8% of patients, 77.5% of relatives). Persons living with at least one relative were more likely to die at home (adjusted odds ratio [aOR] 4.69, 95% confidence interval [CI] 2.71-8.11). According to information supplied by the relatives, the overwhelming majority of patients suffered, two days before death, from moderate to severe weakness (94.9%), fatigue (94.4%), disorientation/confusion (86.9%), and appetite loss (86.4%). Other common symptoms were anxiety (61.0%), tension (59.9%), dyspnea (56.7%), and pain (52.5%). The relatives were critical of the quality of care on standard hospital wards, citing the limited temporal availability of staff and limited emotional support. CONCLUSION These data indicate the high symptom burden of persons with dementia in Germany at the end of their lives. They underscore the need for proper palliative care in all of the settings where persons with dementia die. Specialized in- and outpatient palliative care should not be offered only to patients with cancer, but should rather be made available to all who need it.
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Affiliation(s)
- Luis Carlos Escobar Pinzon
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz.
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Lorenzl S, Nübling G, Perrar KM, Voltz R. Palliative treatment of chronic neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:133-9. [DOI: 10.1016/b978-0-444-53501-6.00010-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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