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Advance Care Planning in Dementia

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https://www.readbyqxmd.com/read/28705196/better-palliative-care-for-people-with-a-dementia-summary-of-interdisciplinary-workshop-highlighting-current-gaps-and-recommendations-for-future-research
#1
Siobhán Fox, Carol FitzGerald, Karen Harrison Dening, Kate Irving, W George Kernohan, Adrian Treloar, David Oliver, Suzanne Guerin, Suzanne Timmons
BACKGROUND: Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but very often is not recognised as such. People with dementia, and their carers, have been shown to have palliative care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not routinely being assessed to determine their palliative care needs, and it is not clear why this is so. MAIN BODY: An interdisciplinary workshop on "Palliative Care in Neurodegeneration, with a focus on Dementia", was held in Cork, Ireland, in May 2016...
July 14, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28694253/implementing-the-compassion-intervention-a-model-for-integrated-care-for-people-with-advanced-dementia-towards-the-end-of-life-in-nursing-homes-a-naturalistic-feasibility-study
#2
Kirsten J Moore, Bridget Candy, Sarah Davis, Anna Gola, Jane Harrington, Nuriye Kupeli, Victoria Vickerstaff, Michael King, Gerard Leavey, Irwin Nazareth, Rumana Z Omar, Louise Jones, Elizabeth L Sampson
BACKGROUND: Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven 'Compassion Intervention' to enhance end-of-life care in advanced dementia. OBJECTIVES: To (1) understand how the Intervention operated in nursing homes in different health economies; (2) collect preliminary outcome data and costs of an interdisciplinary care leader (ICL) to facilitate the Intervention; (3) check the Intervention caused no harm...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28676293/attitudes-toward-advance-directives-among-patients-and-their-family-members-in-china
#3
Lin Kang, Xiao-Hong Liu, Jing Zhang, Pei-Yan Shan, Jie-Ping Wang, Ping Zhong, Xiao-Hong Du, Yu-Feng Du, Bao-Cheng Yu, Nan Wei, Hui-Ling Lou, Ou Bian, Huai-Hong Chen, Fan Lin, Hong-Lian Zhou, Wen He, Huai-Cong Long, Lu-Rong Hong, Hui Su, Jun-Nan Yang, Yong-Liang Jiang, Ye Shi, Jing Ning, Fang Liang, Zhong Wang, Ting Gong, Ming-Lei Zhu, Xiao-Hong Ning, Zhi-Jun Chen, Liang-Kung Chen
OBJECTIVES: Chinese people are generally unfamiliar with the concept of advance care planning or advance directives (ACP/ADs), which raises dilemmas in life-support choice and can even affect clinical decision making. To understand and address the issues involved better, we investigated the awareness of ACP/ADs in China, as well as people's attitudes toward medical autonomy and end-of-life care. DESIGN: A multicenter cross-sectional survey, conducted from August 1 to December 31, 2016...
July 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28651659/a-facilitated-approach-to-family-case-conferencing-for-people-with-advanced-dementia-living-in-nursing-homes-perceptions-of-palliative-care-planning-coordinators-and-other-health-professionals-in-the-ideal-study
#4
Tim Luckett, Lynnette Chenoweth, Jane Phillips, Deborah Brooks, Janet Cook, Geoffrey Mitchell, Dimity Pond, Patricia M Davidson, Elizabeth Beattie, Georgina Luscombe, Stephen Goodall, Thomas Fischer, Meera Agar
BACKGROUND: Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation...
June 27, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28631959/advance-care-planning-for-patients-with-amyotrophic-lateral-sclerosis
#5
Benjamin H Levi, Zachary Simmons, Courtney Hanna, Allyson Brothers, Erik Lehman, Elana Farace, Megan Bain, Renee Stewart, Michael J Green
PURPOSE: To determine whether an advance care planning (ACP) decision-aid could improve communication about end-of-life treatment wishes between patients with amyotrophic lateral sclerosis (ALS) and their clinicians. METHODS: Forty-four patients with ALS (>21, English-speaking, without dementia) engaged in ACP using an interactive computer based decision-aid. Before participants completed the intervention, and again three months later, their clinicians reviewed three clinical vignettes, and made treatment decisions (n = 18) for patients...
August 2017: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
https://www.readbyqxmd.com/read/28596151/survey-on-advance-care-planning-of-italian-outpatients-on-chronic-haemodialysis
#6
Nicola Panocchia, Giuseppe Tonnara, Roberta Minacori, Dario Sacchini, Maurizio Bossola, Luigi Tazza, Giovanni Gambaro, Antonio Gioacchino Spagnolo
OBJECTIVES: The clinical practice guidelines published by the Renal Physicians Association (USA) recommend instituting advance care planning (ACP) for patients with end-stage renal disease. Studies on this issue are lacking in Italy. Our aim was to determine the attitudes of patients on ACP in our dialysis centre. METHODS: We performed a cross-sectional survey. We recruited patients on maintenance haemodialysis (HD) at Hemodialysis Center of Università Cattolica del Sacro Cuore, from 1 March 2014 to 31 March 2015...
June 8, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28593014/a-qualitative-study-on-barriers-to-achieving-high-quality-community-based-integrated-dementia-care
#7
Yoshihisa Hirakawa, Chifa Chiang, Atsuko Aoyama
Introduction: High-quality, community-based dementia care requires a comprehensive, holistic approach. This study aimed to identify the barriers to achieving efficient cooperation and coordination among medical professionals, care managers, and medical social workers, and to improve the management model of community-based, integrated dementia care. Methods: We collected qualitative data through three focus group discussions at JA Konan Kosei Hospital. Thirteen participants (four directors of nursing service departments, three chief nurses, four medical social workers, and two care managers) were recruited for the discussions...
May 2017: Journal of Rural Medicine: JRM
https://www.readbyqxmd.com/read/28574529/prospective-cohort-study-of-hospitalized-adults-with-advanced-cancer-associations-between-complications-comorbidity-and-utilization
#8
Peter May, Melissa M Garrido, Melissa D Aldridge, J Brian Cassel, Amy S Kelley, Diane E Meier, Charles Normand, Joan D Penrod, Thomas J Smith, R Sean Morrison
BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers...
June 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28572521/the-feeding-paradox-in-advanced-dementia-a-local-perspective
#9
J Kh Luk, F Hw Chan, E Hui, C Y Tse
Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding...
June 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28569431/providing-support-to-surrogate-decision-makers-for-people-living-with-dementia-healthcare-professional-organisational-and-community-responsibilities
#10
Christopher Shanley, Deirdre Fetherstonhaugh, Linda McAuliffe, Michael Bauer, Elizabeth Beattie
The prevalence of dementia will continue to increase with the ageing of the population. Many people living with dementia will reach a stage where surrogate decision-makers-mostly family carers-will need to make a range of decisions on their behalf. The aim of this study was to learn from surrogate decision-makers how they can be most effectively supported in this role. The study employed a qualitative design using semi-structured face-to-face or telephone interviews with a purposive sample of 34 surrogate decision-makers of people living with dementia...
June 1, 2017: Health & Social Care in the Community
https://www.readbyqxmd.com/read/28562402/artificial-nutrition-and-hydration-in-people-with-late-stage-dementia
#11
Lenora Smith, Rita Ferguson
The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers...
June 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28521070/drug-therapy-for-symptoms-associated-with-anxiety-in-adult-palliative-care-patients
#12
REVIEW
Susan Salt, Caroline A Mulvaney, Nancy J Preston
BACKGROUND: This is an update of a Cochrane Review first published in 2004 (Issue 1) and previously updated in 2012 (Issue 10). Anxiety is common in palliative care patients. It can be a natural response to the complex uncertainty of having a life-limiting illness or impending death, but it may represent a clinically significant issue in its own right. OBJECTIVES: To assess the effectiveness of drug therapy for treating symptoms of anxiety in adults with a progressive life-limiting illness who are thought to be in their last year of life...
May 18, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28504894/preventing-burdensome-transitions-of-nursing-home-residents-with-advanced-dementia-it-s-more-than-advance-directives
#13
Ruth Palan Lopez, Susan L Mitchell, Jane L Givens
BACKGROUND: Although a palliative approach to care is recommended for people with advanced dementia, many nursing home (NH) residents with dementia experience burdensome interventions such as hospital transfers at the end of life. OBJECTIVE: The goal of this study was to examine how decisions to transfer NH residents with advanced dementia are made, from the perspective of NH nurses and physicians. METHODS: A qualitative, descriptive method was used...
May 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28485515/consensus-statement-of-the-international-summit-on-intellectual-disability-and-dementia-related-to-end-of-life-care-in-advanced-dementia
#14
Philip McCallion, Mary Hogan, Flavia H Santos, Mary McCarron, Kathryn Service, Sandy Stemp, Seth Keller, Juan Fortea, Kathleen Bishop, Karen Watchman, Matthew P Janicki
BACKGROUND: Adults with intellectual disability are affected by dementia at equivalent and elevated rates, many surviving into advanced age. End of life care and support considerations come into play among these individuals when most are in the advanced stage of dementia. METHODS: A preliminary report summarizing available literature and making initial recommendations was developed by a workgroup, reviewed by all conference participants and then was finalized by the workgroup...
May 9, 2017: Journal of Applied Research in Intellectual Disabilities: JARID
https://www.readbyqxmd.com/read/28472970/communicating-mild-cognitive-impairment-diagnoses-with-and-without-amyloid-imaging
#15
REVIEW
Joshua D Grill, Liana G Apostolova, Szofia Bullain, Jeffrey M Burns, Chelsea G Cox, Malcolm Dick, Dean Hartley, Claudia Kawas, Sarah Kremen, Jennifer Lingler, Oscar L Lopez, Mark Mapstone, Aimee Pierce, Gil Rabinovici, J Scott Roberts, Seyed Ahmad Sajjadi, Edmond Teng, Jason Karlawish
BACKGROUND: Mild cognitive impairment (MCI) has an uncertain etiology and prognosis and may be challenging for clinicians to discuss with patients and families. Amyloid imaging may aid specialists in determining MCI etiology and prognosis, but creates novel challenges related to disease labeling. METHODS: We convened a workgroup to formulate recommendations for clinicians providing care to MCI patients. RESULTS: Clinicians should use the MCI diagnosis to validate patient and family concerns and educate them that the patient's cognitive impairment is not normal for his or her age and education level...
May 4, 2017: Alzheimer's Research & Therapy
https://www.readbyqxmd.com/read/28428907/palliative-care-in-huntington-disease-personal-reflections-and-a-review-of-the-literature
#16
REVIEW
Christopher G Tarolli, Amy M Chesire, Kevin M Biglan
BACKGROUND: Huntington disease is a fatal, autosomal dominant, neurodegenerative disorder manifest by the triad of a movement disorder, behavioral disturbances, and dementia. At present, no curative or disease modifying therapies exist for the condition and current treatments are symptomatic. Palliative care is an approach to care that focuses on symptom relief, patient and caregiver support, and end of life care. There is increasing evidence of the benefit of palliative care throughout the course of neurodegenerative conditions including Parkinson disease and amyotrophic lateral sclerosis...
2017: Tremor and Other Hyperkinetic Movements
https://www.readbyqxmd.com/read/28407800/advance-directives-and-power-of-attorney-for-health-care-in-the-oldest-old-results-of-the-agequalide-study
#17
Tobias Luck, Francisca S Rodriguez, Birgitt Wiese, Carolin van der Leeden, Kathrin Heser, Horst Bickel, Jürgen In der Schmitten, Hans-Helmut Koenig, Siegfried Weyerer, Silke Mamone, Tina Mallon, Michael Wagner, Dagmar Weeg, Angela Fuchs, Christian Brettschneider, Jochen Werle, Martin Scherer, Wolfgang Maier, Steffi G Riedel-Heller
BACKGROUND: Completion of advance directives (ADs) and power of attorney (POA) documents may protect a person's autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA. METHODS: We analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study...
April 13, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28364258/dementia-care-management-in-primary-care-current-collaborative-care-models-and-the-case-for-interprofessional-education
#18
Adina Dreier-Wolfgramm, Bernhard Michalowsky, Mary Guerriero Austrom, Marjolein A van der Marck, Steve Iliffe, Catherine Alder, Horst Christian Vollmar, Jochen René Thyrian, Diana Wucherer, Ina Zwingmann, Wolfgang Hoffmann
BACKGROUND: Dementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient's healthcare needs. They can be described as "collaborative care" or "person-centered care". Referring to the needs of the workforce working with persons with dementia, a key element is the use of interprofessional education (IPE). OBJECTIVE: The purpose of this article is to describe different international collaborative care models to define a minimum standard of healthcare professions for collaborative dementia care in primary care...
March 31, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28361632/advance-care-planning-for-people-with-dementia
#19
(no author information available yet)
UK policy and guidance state that people should have their preferences and priorities for end of life care recorded in the form of an advance care plan. However, for people with dementia and their families, issues of reduced capacity, difficulties with discussing end of life preferences and staff understanding can make this process challenges. This research focus summarises two studies that explore these issues.
March 31, 2017: Nursing Older People
https://www.readbyqxmd.com/read/28353140/antimicrobial-use-in-patients-with-dementia-current-concerns-and-future-recommendations
#20
Carole Parsons, Jenny T van der Steen
Infections are common in people with dementia, and antibiotic use is widespread, albeit highly variable, across healthcare settings and countries. The few studies conducted to date that consider the appropriateness of antibiotic prescribing specifically for people with dementia focus on people with advanced dementia and suggest that much of the prescribing of antibiotics for these patients may be potentially inappropriate. We suggest that clinicians must consider a number of factors to determine appropriateness of antimicrobial prescribing for people with dementia, including the risks and benefits of assessing and treating infections, the uncertainty regarding the effects of antibiotics on patient comfort, goals of care and treatment preferences, hydration status, dementia severity and patient prognosis...
March 28, 2017: CNS Drugs
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