Why do we delay palliative care for patients with dementia?
Palliative care has a lot to offer patients with dementia. When it comes to palliative care services, we are discovering that "the precedent, the best" applies to many diseases. However, for patients with advanced dementia, palliative care consultations are rare and access is limited.
Many patients with advanced dementia are resident in long-term care facilities, where pain, feeding difficulties and shortness of breath, all of which are susceptible to palliative care, are common. Patients with near-death dementia are often admitted to hospitals for acute care, in which case family members may have difficulty with treatment decisions that support the lives of their loved ones.
To find out if it would be feasible and useful for hospitalization, serve as an incentive for palliative care counseling, a pilot trial was conducted with 62 couples of patients with advanced dementia and their main family decision makers. The dyads were randomly assigned to specialist advice in palliative care or to usual care for the duration of the patient's hospitalization. Patients in the treatment group received palliative care with protocol during hospitalization, and family members received telephone assistance from a palliative care nurse for 2 weeks after discharge.
Specialized palliative care counseling for patients with advanced dementia caused by hospitalization due to acute illness has proved feasible. Although the intervention has not reduced hospitalization rates by 60 days or emergency room visits, compared to the usual hospital care, the triggered palliative care consultation was effective in important areas such as advance directives, repatriation assistance to hospices, discussions on prognosis and decisions taken by families to avoid future admissions
Point of view
This study is aimed at one of the poorest palliative care populations: patients with advanced dementia. Some very real advantages have been observed for patients and families when these patients had access to special palliative care services. With long-term follow-up, the results are likely to have improved as well.
In the ever-growing palliative care sector, triggers can serve as inflection points to improve the care of patients with serious chronic illnesses. This timely pilot study recognized the unique needs of the population in advanced dementia, including the need to improve transitional care when these patients returned to long-term care facilities or at home. Palliative care can address the critical concerns of patients and family caregivers, promote necessary but difficult discussions and respect the wishes of people dealing with advanced dementia.[4,5,6]