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palliative Care dementia

Sarah Amador, Claire Goodman, Louise Robinson, Elizabeth L Sampson
BACKGROUND: People living and dying with non-cancer diagnoses, including dementia, have poorer access to generalist and specialist palliative care than people with cancer, and experience worse outcomes in terms of pain and symptom control, and quality and experience of care. In the UK, the National Council for Palliative Care (NCPC) ran a national survey of services for end-of-life care for people with dementia (2008) in which 16 services were identified, and reported on case studies and examples of good practice...
October 14, 2016: BMJ Supportive & Palliative Care
Tammy Vu Bach, Jonathan Pan, Anne Kirstein, Cindy Joanne Grief, Daphna Grossman
Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally...
October 11, 2016: Journal of Palliative Medicine
Kirsten Hermans, Joachim Cohen, Nele Spruytte, Chantal Van Audenhove, Anja Declercq
AIM: The aims of the present study were: (i) to describe palliative care needs and symptoms of older adults anticipated to be in the last year of their life in Flemish nursing homes (Belgium); and (ii) to evaluate whether these needs differ between residents with and without dementia. METHODS: A cross-sectional study was carried out in 2014. Nurses and nursing assistants in 15 Flemish nursing homes (Belgium) completed the Palliative care Outcome Scale for 109 residents with palliative care needs...
September 16, 2016: Geriatrics & Gerontology International
J Brian Cassel, Kathleen M Kerr, Donna K McClish, Nevena Skoro, Suzanne Johnson, Carol Wanke, Daniel Hoefer
OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity-based matching. SETTING: A health system in southern California. PARTICIPANTS: Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia...
September 2, 2016: Journal of the American Geriatrics Society
Gloria Bonner, Sharon Williams, Diana Wilkie, Alysha Hart, Glenda Burnett, Geraldine Peacock
BACKGROUND: An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions...
August 30, 2016: American Journal of Hospice & Palliative Care
Radka Bužgová, Radka Kozáková, Lucie Sikorová, Darja Jarošová
OBJECTIVES: The study aimed to assess the psychometric properties of the Czech versions of the Quality of Life in Late-Stage Dementia (QUALID) and the Cognitively Impaired Life Quality (CILQ) scales for use in the palliative care setting in terminally ill patients with cognitive impairment. METHODS: The sample comprised 306 cognitively impaired inpatients with advanced cancer and non-cancer conditions. In this cross-sectional study, two Quality of Life (QoL) measurements were performed at baseline and after five days...
August 26, 2016: Aging & Mental Health
Adam E Singer, Joy R Goebel, Yan S Kim, Sydney M Dy, Sangeeta C Ahluwalia, Megan Clifford, Elizabeth Dzeng, Claire E O'Hanlon, Aneesa Motala, Anne M Walling, Jaime Goldberg, Daniella Meeker, Claudia Ochotorena, Roberta Shanman, Mike Cui, Karl A Lorenz
IMPORTANCE: Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE: To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system...
September 2016: Journal of Palliative Medicine
Anne O'Reilly
What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article discussed the difference between palliative care and end of life care. It explored the provision of dementia care in care homes and how to optimise palliative and end of life care.
August 17, 2016: Nursing Standard
Christine S Ritchie, Amy S Kelley, Irena Stijacic Cenzer, Alexander K Smith, Margaret L Wallhagen, Kenneth E Covinsky
CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care. OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture...
August 9, 2016: Journal of Pain and Symptom Management
Shirley Harvey Bush, Nathalie Lacaze-Masmonteil, Marie Theresa McNamara-Kilian, Alistair Richard MacDonald, Sallyanne Tierney, Franco Momoli, Meera Agar, David Christopher Currow, Peter Gerard Lawlor
BACKGROUND: Delirium is a very common and distressing neuropsychiatric syndrome in palliative care. Increasing age, the presence of dementia and advanced cancer are well-known predisposing risk factors for delirium development. Sleep-wake cycle disturbance is frequently seen during delirium and melatonin has a pivotal role in the regulation of circadian rhythms. Current evidence across various settings suggests a potential preventative role for melatonin in patients at risk of delirium, but no studies are currently reported in patients with advanced cancer...
2016: Trials
Nathan Davies, Rammya Mathew, Jane Wilcock, Jill Manthorpe, Elizabeth L Sampson, Kethakie Lamahewa, Steve Iliffe
BACKGROUND: The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. METHODS: An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals...
2016: BMC Palliative Care
(no author information available yet)
The CPD article Palliative and end of life care for people living with dementia in care homes: part 2 (29 June 2016) wrongly referred to oxycodone as a 'mild' opioid. Oxycodone is a controlled opioid for the management of high levels of pain and care must be taken in its administration.
August 3, 2016: Nursing Standard
Niklas Schmedt, Bianca Kollhorst, Dirk Enders, Kathrin Jobski, Jutta Krappweis, Edeltraut Garbe, Tania Schink
Although the use of antipsychotics has been associated with an increased risk of death, data on the safety of individual substances is scarce. We thus aimed to compare the risk of death in new users of individual antipsychotics aged =>65 years and conducted a cohort study in the German Pharmacoepidemiological Research Database between 2005 and 2011. Patients were followed from initiation of treatment until death, 90 days after cohort entry, end of insurance or the end of the study period. Multivariable cox regression was used to estimate confounder adjusted hazard ratios (aHR) of death for 14 individual antipsychotics compared to risperidone...
September 2016: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
Elizabeth Hanson, Amanda Hellström, Åsa Sandvide, Graham A Jackson, Rhoda MacRae, Anna Waugh, Wilson Abreu, Debbie Tolson
This article presents an integrative literature review of the experience of dementia care associated with the extended palliative phase of dementia. The aim was to highlight how dementia is defined in the literature and describe what is known about the symptomatology and management of advanced dementia regarding the needs and preferences of the person with dementia and their family carer/s. There was no consistent definition of advanced dementia. The extended palliative phase was generally synonymous with end-of-life care...
July 26, 2016: Dementia
R Mathew, N Davies, J Manthorpe, S Iliffe
OBJECTIVE: Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used...
2016: BMJ Open
Ragni Sommerbakk, Dagny Faksvåg Haugen, Aksel Tjora, Stein Kaasa, Marianne Jensen Hjermstad
BACKGROUND: Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway...
2016: BMC Palliative Care
Rogier H P D van Deijck, Jeroen G J Hasselaar, Stans C A H H V M Verhagen, Kris C P Vissers, Raymond T C M Koopmans
CONTEXT: A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS. OBJECTIVES: To identify the course of discomfort in patients receiving CPS. METHODS: A prospective observational multicenter study in nine hospices and palliative care units was performed...
September 2016: Journal of Pain and Symptom Management
J Diehl-Schmid, S Richard-Devantoy, T Grimmer, H Förstl, R Jox
OBJECTIVE: The aim of the present study was to gain insight into the living and care situation in advanced behavioral variant frontotemporal dementia (bvFTD), to describe symptoms and findings in advanced bvFTD, and to evaluate somatic comorbidities and circumstances of death. METHODS: Standardized interviews were conducted with family caregivers of 83 patients with bvFTD. Forty-four percent of the patients were already deceased at the time of the interview. RESULTS: At the time of the interview or death, respectively, 47% of the patients lived in a nursing home...
July 4, 2016: International Journal of Geriatric Psychiatry
Melissa W Wachterman, Corey Pilver, Dawn Smith, Mary Ersek, Stuart R Lipsitz, Nancy L Keating
IMPORTANCE: Efforts to improve end-of-life care have focused primarily on patients with cancer. High-quality end-of-life care is also critical for patients with other illnesses. OBJECTIVE: To compare patterns of end-of-life care and family-rated quality of care for patients dying with different serious illnesses. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among patients who died in inpatient facilities between October 1, 2009, and September 30, 2012, with clinical diagnoses categorized as end-stage renal disease (ESRD), cancer, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease), dementia, frailty, or other conditions...
August 1, 2016: JAMA Internal Medicine
G M Johnston, R Urquhart, L Lethbridge, M MacIntyre
Background: Screening and treatment for breast cancer have improved. However, attention to palliative support and non-cancer co-morbidities has been limited. This study identified types of care for and co-morbidities of persons dying of breast cancer compared to persons dying from all cancers and from non-cancer causes. Methods: Linked administrative data from population-based registries were used to examine 121,458 deaths in Nova Scotia from 1995 to 2009. Results: Breast cancer decedents' mean age was similar to that of all cancer decedents (72...
May 3, 2016: Progress in Palliative Care
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