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Marín-Medina DS, Bautista-Mier H, Perilla-Orozco DM, Sánchez-Duque JA. Geriatric palliative care in advanced dementia. Rev Clin Esp 2024; 224:117-118. [PMID: 38228268 DOI: 10.1016/j.rceng.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- D S Marín-Medina
- Grupo de Investigación NeuroUNAL, Unidad de Neurología, Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C., Colombia; Grupo de Investigación Epidemiología, Salud y Violencia. Unidad de Epidemiología, Departamento de Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - H Bautista-Mier
- Grupo de Investigación GeriaUNAL - Griego. Unidad de Geriatría, Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá D.C., Colombia
| | - D M Perilla-Orozco
- Grupo de Investigación Salud, Familia y Sociedad, Unidad de Medicina Familiar, Departamento de Medicina Social y Salud Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia
| | - J A Sánchez-Duque
- Grupo de Investigación Epidemiología, Salud y Violencia. Unidad de Epidemiología, Departamento de Medicina Comunitaria, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Grupo de Investigación GeriaUNAL - Griego. Unidad de Geriatría, Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá D.C., Colombia.
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Fox S, Drennan J, Guerin S, Kernohan WG, Murphy A, O'Connor N, Rukundo A, Timmons S. A comparison of four dementia palliative care services using the RE-AIM framework. BMC Geriatr 2023; 23:677. [PMID: 37858076 PMCID: PMC10585827 DOI: 10.1186/s12877-023-04343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. METHODS A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. RESULTS The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. CONCLUSIONS An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.
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Affiliation(s)
- Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, County Antrim, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - Niamh O'Connor
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Aphie Rukundo
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Flaherty CN, Carter PA, Smith L, Lerner N, Hooper G, Bail JR. Community-based early dementia advance care planning in the United States: A scoping review. Geriatr Nurs 2023; 52:63-72. [PMID: 37247492 DOI: 10.1016/j.gerinurse.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Christine Noelle Flaherty
- Joint Nursing Science Ph.D. Program, The University of Alabama in Huntsville, Huntsville, Alabama, USA; The University of Alabama, Tuscaloosa, Alabama, USA.
| | - Patricia A Carter
- The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA.
| | - Lenora Smith
- The University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, USA.
| | - Nancy Lerner
- The University of Maryland School of Nursing, Baltimore, Maryland, USA.
| | - Gwendolyn Hooper
- The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA.
| | - Jennifer R Bail
- The University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, USA.
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Juhrmann ML, San Martin A, Jaure A, Poulos CJ, Clayton JM. Staff perspectives on end-of-life care for people living with dementia in residential aged care homes: qualitative study. Front Psychiatry 2023; 14:1137970. [PMID: 37181908 PMCID: PMC10166813 DOI: 10.3389/fpsyt.2023.1137970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction People living with dementia in care homes can benefit from palliative approaches to care; however, not all will require specialist palliative care. The generalist aged care workforce is well placed to provide most of this care with adequate training and support systems in place, but little is known about their experiences. Objective To describe staff perspectives on providing quality end-of-life care for people living with dementia in residential care and their families. Methods Focus groups and semi-structured interviews were conducted with residential aged care managerial and frontline staff in Australia who were caring for residents living with dementia and end-of life needs. A comprehensive, then snowballing sampling strategy was used in participating care homes. Transcripts were analyzed using reflexive thematic analysis. Results Fifteen semi-structured interviews and six focus groups were undertaken with 56 participants across 14 sites across two Australian states. Five themes were identified: putting the resident at the center (creating homes not hospitals, knowing the individual, a case management approach); articulating goals to grant wishes (initiating the conversation, broadening death literacy, avoiding hospitalization); a collective call to action (staffing the home, recognizing deterioration and escalating issues, communication channels and engaging GPs, managing medications, psychosocial supports); educating to empower staff (governance and guidance, mentoring juniors, self-care); and facilitating family acceptance (setting expectations, partnering in care, access at all hours). Discussion Aged care staff are committed to providing person-centered palliative and end-of-life care for people living with dementia, recognizing the intrinsic value of each resident, regardless of their declining state. Frontline and managerial staff consider advance care planning, collectively working as part of a multidisciplinary team, access to targeted palliative and end-of-life education and training, and engaging families as key priorities to providing high quality care in care homes.
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Affiliation(s)
- Madeleine L. Juhrmann
- The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Aljon San Martin
- The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
| | - Allison Jaure
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Christopher J. Poulos
- Centre for Positive Ageing, HammondCare, Hammondville, NSW, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Josephine M. Clayton
- The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
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Ke LS, Cheng HC, Liu CL, Ku YC, Lee MJ, Lin YL, Huang HY. Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3430. [PMID: 36834122 PMCID: PMC9959590 DOI: 10.3390/ijerph20043430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Asians believe discussing death-related topics is inauspicious and may bring bad luck. It is critical to explore the end-of-life care preferences of the Asian elderly with less-threatening tools. The study examined older adults' preferences regarding end-of-life treatments by applying a cartoon version of the Life Support Preferences Questionnaire (LSPQ). A cross-sectional survey was conducted to understand older adults' preferences for end-of-life treatments. A total of 342 older adults participated in the study, comprising 268 elderly patients from a veterans hospital located in northern Taiwan and 74 elderly family members of the patients. Regardless of scenario, cardiopulmonary resuscitation (CPR) had the lowest score, indicating that older adults considered it a less desirable medical treatment. By contrast, antibiotics and intravenous infusions had the highest scores, indicating that older adults tended to prefer them. End-of-life care preferences were significantly different in genders. CPR and surgical preferences of older adults differed significantly with education level. Different demographic characteristics had different end-of-life treatment preferences, and future research may develop advance care planning programs for different attributes. This cartoon version of the LSPQ can help healthcare professionals to understand older adults' preferences for end-of-life care and warrants further empirical research.
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Affiliation(s)
- Li-Shan Ke
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Hui-Chuan Cheng
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chien-Liang Liu
- Department of Neurology, Taipei City Hospital, Taipei 110, Taiwan
| | - Yu-Chen Ku
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ming-Ju Lee
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yin-Ling Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Hsiu-Ying Huang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
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