Pilot Testing of Aliviado Dementia Care-Hospice Edition —A Quality Assurance and Performance Improvement Program for Better Hospice Dementia Care (FR421D)
Forty-five percent of U.S. hospice recipients have either a primary diagnosis of advanced dementia or dementia as a comorbidity. However, largely due to the lack of experience and knowledge of dementia-related symptomatology, hospice clinicians are underprepared to treat patients without hospice-specific dementia training programs.
Dementia management is complicated by neuropsychiatric symptoms such that the longitudinal care of a psychiatrist or other mental health provider is often an essential part of patient care and a major source of family support. Given the importance of end-of-life continuity of care, the involvement of psychiatry in palliative and hospice services affords an important opportunity for growth. Common challenges involve sharing prognostic information with patients and families to aid in advance planning, and management of persistent pain and nutritional issues. Future research will yield important new insights and guidelines for care.
CONCLUSIONS: To prevent excessive decline in physical performance in this population, NH clinicians should focus efforts specifically on assessment of physical performance at admission and on identification and management of musculoskeletal pain and neuropsychiatric symptoms. PMID: 32060802 [PubMed - as supplied by publisher]
Conclusions In this national survey of individuals with PD, we identified poor QOL, frequent critical events, and numerous uncontrolled symptoms among a substantial proportion of respondents. Although motor symptoms were common, only nonmotor symptoms were associated with poor QOL. Many of these symptoms and events are treatable or preventable, highlighting the need for better identification and management to improve QOL among those with PD.
Condition: Dementia Interventions: Other: dementia pain care education; Other: dementia care education Sponsor: Kaohsiung Medical University Chung-Ho Memorial Hospital Completed
Treatment-refractory psychosis (TRP) is a controversial term in the setting of the current societal stigma and medical understanding or misunderstanding of mental illness. However, there is recognition that patients with either advanced mental illness (i.e. schizophrenia) in the setting of terminal diseases such as cancer or certain neurologic diseases (i.e. Huntington's disease and Lewy body dementia) can result in psychotic states not amendable to conventional pharmacologic and non-pharmacologic treatments.
Historically, palliative care has primarily served individuals with serious physical illnesses. People with dementia and their families, however, represent a growing population in the United States who are increasingly accessing hospice and palliative care. It is not well understood how and how well the unique needs of this population are being met by the current scope and approaches of palliative care. In this concurrent session, we will discuss this topic in light of our original mixed-methods data collection, reviews of scholarly literature, and participation from attendees.
Dementia patients are at high risk for preventable hospital readmission. This population could benefit from expert consultation in SNF to reduce readmission rates. Community-based palliative medicine focusing on symptom management and goals of care in post-acute care facilities can lower unnecessary transitions, hospitalization, and emergency department visits; reduce length of stay; and lower Medicare expenditures.
Dementias are progressive and incurable, leading to a profound loss of cognitive function with a final phase characterized by reduced oral intake. The availability of medical nutrition has made treatment decisions more complex for surrogates, and despite studies and National Society recommendations to the contrary, many physicians continue to place feeding tubes in patients with dementia.
In patients with cognitive impairments who are unable to self-report pain, providers must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking.
While most patients with Alzheimer's and Related Dementias (ADRD) prefer to die in nursing facilities, trends and factors associated with place of death for this population remain unknown.