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Advance Care Planning in Dementia

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https://www.readbyqxmd.com/read/28330545/-treatment-of-chronic-diseases-in-patients-with-dementia
#1
Hanne Pedersen, Kristian Skikkild Klinkby, Frans Borch Waldorff
Comorbidity is common in patients with dementia, and due to the nature of the dementia disease, patients with dementia have special challenges in relation to comorbidity. This article is about dementia and heart failure, chronic obstructive pulmonary disease, urinary incontinence, falls, polypharmacy and chronic pain. Ongoing goal setting is important, and advance care planning is recommended. In general, comorbidity must be carefully and holistic assessed and managed according to each patient's general status of health and stage of dementia...
March 20, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28330379/patient-self-defined-goals
#2
Sandra Ellen Schellinger, Eric Worden Anderson, Monica Schmitz Frazer, Cindy Lynn Cain
This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28244346/preferences-of-residents-with-dementia-for-end-of-life-care
#3
Kiri Mulqueen, Alice Coffey
Aim To explore the preferences of residents with dementia for their end of life care, and nurses' perceptions of these preferences. Method Residents' preferences were compared with nurses' perceptions of their preferences in a qualitatively designed study in which the nominal group technique was adopted for data collection. Findings Some of the residents' preferences for their end of life care matched nurses' perceptions of their preferences, but differences were identified. Residents emphasised comfort, family presence, familiar staff and surroundings; nurses thought that residents would want good communication, pain management, advance care planning, being cared for by knowledgeable staff and the inclusion of their families...
February 28, 2017: Nursing Older People
https://www.readbyqxmd.com/read/28132606/healthcare-decision-making-past-present-and-future-in-light-of-a-diagnosis-of-dementia
#4
Karen Harrison Dening, Michael King, Louise Jones, Elizabeth L Sampson
End-of-life care policy in the UK states that all people should identify their needs, priorities and preferences for end-of-life care in the form of advance care planning. Advance care planning in dementia is less well developed than in some other disease groups such as cancer and, arguably, may be more complex. A person with dementia may lose the capacity to make decisions associated with advance care planning early in the course of the disease, requiring more involvement of family carers. This study explores the 'lived' context to health care decision-making of dyads (the person with dementia and their carer) in respect of past, present and future healthcare decision-making...
January 2, 2017: International Journal of Palliative Nursing
https://www.readbyqxmd.com/read/28086861/managing-shades-of-grey-a-focus-group-study-exploring-community-dwellers-views-on-advance-care-planning-in-older-people
#5
Natasha Michael, Clare O'Callaghan, Emma Sayers
BACKGROUND: Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community. METHODS: Qualitative descriptive research, which included focus groups with older people (55+ years) and older people's offspring/caregivers living in an Australian city and surrounding rural region...
January 13, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28078098/transfer-of-nursing-home-residents-to-emergency-departments-organizational-differences-between-nursing-homes-with-high-vs-low-transfer-rates
#6
Marie Kirsebom, Mariann Hedström, Ulrika Pöder, Barbro Wadensten
AIM: To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department. DESIGN: Explorative. METHOD: In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department...
January 2017: Nursing Open
https://www.readbyqxmd.com/read/28069027/reliability-of-health-related-quality-of-life-assessments-made-by-older-adults-and-significant-others-for-health-states-of-increasing-cognitive-impairment
#7
Gina Bravo, Modou Sene, Marcel Arcand
BACKGROUND: Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time. The accuracy with which significant others can predict how an older adult envisions HRQoL in a future state of cognitive impairment is also unknown...
January 7, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28068789/pragmatic-trial-of-video-education-in-nursing-homes-the-design-and-rationale-for-a-pragmatic-cluster-randomized-trial-in-the-nursing-home-setting
#8
Vincent Mor, Angelo E Volandes, Roee Gutman, Constantine Gatsonis, Susan L Mitchell
Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28001137/covert-medications-act-of-compassion-or-conspiracy-of-silence
#9
Robert C Macauley
As the population in the United States gets older, more people suffer from dementia, which often causes neuropsychiatric symptoms such as agitation and paranoia. This can lead patients to refuse medications, prompting consideration of covert administration (that is, concealing medication in food or drink). While many condemn this practice as paternalistic, deceptive, and potentially harmful, the end result of assuming the "moral high ground" can be increased suffering for patients and families. This article addresses common criticisms of covert medication and presents a detailed algorithm by which to determine whether the practice is ethically permissible in specific cases...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27999476/advancing-aged-care-a-systematic-review-of-economic-evaluations-of-workforce-structures-and-care-processes-in-a-residential-care-setting
#10
REVIEW
Tiffany Easton, Rachel Milte, Maria Crotty, Julie Ratcliffe
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only...
2016: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/27995678/nursing-home-manager-s-knowledge-attitudes-and-beliefs-about-advance-care-planning-for-people-with-dementia-in-long-term-care-settings-a-cross-sectional-survey
#11
Esther-Ruth Beck, Sonja McIlfatrick, Felicity Hasson, Gerry Leavey
AIMS AND OBJECTIVES: To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. BACKGROUND: Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective...
December 20, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27976624/palliative-care-for-dementia-patients
#12
France Hirot
Dementia is a life-limiting disease without curative treatments but the data suggest that advanced dementia is not viewed as a terminal diagnosis by physicians. Although symptoms of dementia and cancer patients are similar, palliative care is less frequently proposed for dementia patients. However, professionals and family members of demented patients strongly favor comfort care for end-stage dementia. To improve the patients' relief near the end of life, advance care planning with patients and their proxies should be encouraged...
December 1, 2016: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/27911489/palliative-care-interventions-in-advanced-dementia
#13
REVIEW
Edel Murphy, Katherine Froggatt, Sheelah Connolly, Eamon O'Shea, Elizabeth L Sampson, Dympna Casey, Declan Devane
BACKGROUND: Dementia is a chronic, progressive and ultimately fatal neurodegenerative disease. Advanced dementia is characterised by profound cognitive impairment, inability to communicate verbally and complete functional dependence. Usual care of people with advanced dementia is not underpinned universally by a palliative approach. Palliative care has focused traditionally on care of people with cancer but for more than a decade, there have been increased calls worldwide to extend palliative care services to include all people with life-limiting illnesses in need of specialist care, including people with dementia...
December 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27911320/ethnic-variations-in-prognosis-of-patients-with-dementia-a-prospective-nationwide-registry-linkage-study-in-the-netherlands
#14
Charles Agyemang, Irene E van de Vorst, Huiberdina L Koek, Michiel L Bots, Azizi Sexas, Marie Norredam, Umar Ikram, Karien Stronks, Ilonca Vaartjes
BACKGROUND: Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed...
November 29, 2016: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/27895004/predictors-of-vascular-cognitive-impairment-poststroke-in-a-middle-eastern-bahrain-cohort-a-proposed-case-control-comparison
#15
Claire Donnellan, Mona Al Banna, Noor Redha, Adel Al Jishi, Isa Al Sharoqi, Safa Taha, Moiz Bakhiet, Fatema Abdulla, Patrick Walsh
BACKGROUND: Poststroke dementia and cognitive impairment are associated with poor long-term outcomes after stroke. The contribution of genetic factors such as the presence of apolipoprotein (ApoE) ɛ4 allele and its association with cognitive impairment poststroke remains inconclusive, particularly in Middle Eastern regions. OBJECTIVE: The aim of this study is to examine all correlates and potential predictors of cognitive impairment including self-awareness and regulation deficits in stroke patients and compare these functions with healthy older adults from a Middle Eastern population...
November 28, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27893884/effect-of-the-goals-of-care-intervention-for-advanced-dementia-a-randomized-clinical-trial
#16
Laura C Hanson, Sheryl Zimmerman, Mi-Kyung Song, Feng-Chang Lin, Cherie Rosemond, Timothy S Carey, Susan L Mitchell
Importance: In advanced dementia, goals of care decisions are challenging and medical care is often more intensive than desired. Objective: To test a goals of care (GOC) decision aid intervention to improve quality of communication and palliative care for nursing home residents with advanced dementia. Design, Setting, and Participants: A single-blind cluster randomized clinical trial, including 302 residents with advanced dementia and their family decision makers in 22 nursing homes...
January 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27859597/quality-of-care-for-people-with-dementia-and-professional-caregivers-perspectives-regarding-palliative-care-in-japanese-community-care-settings
#17
Miharu Nakanishi, Kayo Hirooka, Yuko Morimoto, Atsushi Nishida
OBJECTIVE: Palliative care for dementia includes psychosocial interventions as first-line treatment for challenging behaviour. However, the national dementia plan in Japan contradicts recommendations for palliative care for dementia. This study aimed to examine the association between care quality for patients with dementia and professional caregivers' perspectives regarding palliative care for dementia in Japanese community care settings. METHODS: In total, 2116 professional caregivers from 329 agencies (217 in-home long-term care support providers; 29 small-scale, multiple home-care providers; and 83 group homes) in Tokyo prefecture, Japan, completed cross-sectional, paper-based questionnaires about 3603 people diagnosed with dementia, in May 2016...
November 17, 2016: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27849637/pneumonia-intake-problems-and-survival-among-nursing-home-residents-with-variable-stages-of-dementia-in-the-netherlands-results-from-a-prospective-observational-study
#18
Simone A Hendriks, Martin Smalbrugge, Arianne B van Gageldonk-Lafeber, Francisca Galindo-Garre, Maarten Schipper, Cees M P M Hertogh, Jenny T van der Steen
OBJECTIVES: We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. METHODS: In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S)...
November 15, 2016: Alzheimer Disease and Associated Disorders
https://www.readbyqxmd.com/read/27821714/end-of-life-care-a-scoping-review-of-experiences-of-advance-care-planning-for-people-with-dementia
#19
Kerry Jones, Giles Birchley, Richard Huxtable, Linda Clare, Tony Walter, Jeremy Dixon
Despite increasing attention given to dementia by international governments and policy makers, the focus of end of life care has been on the dying trajectory of malignant disease. People with severe dementia have complex physical and psychological needs, yet the disease is not always recognised as terminal. Advance Care Planning involving people with dementia and their families can provide opportunities to discuss and later, initiate timely palliative care.We conducted a scoping review of studies exploring decisions associated with the EoLC of people with dementia...
November 7, 2016: Dementia
https://www.readbyqxmd.com/read/27807088/shared-decision-making-for-people-living-with-dementia-in-extended-care-settings-protocol-for-a-systematic-review
#20
Rachel Daly, Frances Bunn, Claire Goodman
INTRODUCTION: Approximately 450 000 people in the UK are living in care homes, 70% of whom are thought to have dementia or significant memory problems. This means that they may need support with day-to-day decisions about their health and care. Shared decision-making interventions can have a positive impact on patient outcomes. They recognise an individual's rights to make decisions about their care or treatment and support person-centred approaches to care delivery. METHODS: A systematic review of studies designed to assess, implement, measure and/or explore shared decision-making with cognitively impaired adults in (or transferrable to) an extended care setting, with a view to answering the research question: How can people living with dementia and cognitive impairment be included in day-to-day decisions about their health and care in extended care settings? The systematic review will be started in May 2016...
November 2, 2016: BMJ Open
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