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Advance Care Planning in Dementia

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https://www.readbyqxmd.com/read/28521070/drug-therapy-for-symptoms-associated-with-anxiety-in-adult-palliative-care-patients
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
(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
#9
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
https://www.readbyqxmd.com/read/28351268/find-yourself-a-suitable-mentor
#10
(no author information available yet)
Karen Harrison Dening has more than 40 years of nursing experience, more than 30 of which are in dementia care. She has worked for charity Dementia UK for the past ten years, initially as a consultant Admiral Nurse specialist and then as head of research and evaluation. For her PhD from University College London she focused on advance care planning and end of life care in dementia. She holds honorary academic positions at the universities of Liverpool and Nottingham, where she lectures and is involved in research...
March 29, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28330545/-treatment-of-chronic-diseases-in-patients-with-dementia
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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...
April 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
#19
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
#20
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
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