New Evidence-Based Guidelines for Dementia Palliative Care (FR418)
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.
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.
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.
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.
Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care.
The American population is getting older and sicker. More Americans are facing life-threatening illness when approaching end of life. Palliative care has grown to meet the complex needs of this population. And yet, according to a 2017 article in the journal Palliative Care, many people living with a chronic life-threatening illness either do not receive any palliative care, or receive services only in the last phase of their illness. The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care also addressed this issue, stating that a goal of their recently updated guidelines is “to improve...
Conclusions and RelevanceAlthough a high proportion of patients received elements of palliative care, transitions to a goal of comfort or hospice happened very near death. Palliative care delivery can be improved by systematizing existing mechanisms, including prompts for earlier goals-of-care discussion, symptom screening, and spiritual care, and by building collaboration between primary and specialty palliative care services.
ConclusionOur baseline data highlights that education and change implementation needs to be tailored to the recipient site, recognising site-specific barriers to change. We will now use this data in our Work-based Learning intervention.
Abstract For a growing number of persons with dementia (PWDs), advance care planning (ACP) can help families make important end-of-life (EOL) care decisions that reflect PWDs' values and preferences. The current exploratory study aimed to understand advance directive planning and decision making among PWDs and caregivers. A survey was conducted with a convenience sample of 47 ethnically diverse PWD caregivers recruited from rural health care facilities in Southwest Texas. Sixty-eight percent of PWDs and caregivers were Hispanic. The majority of PWDs had completed an advance directive (60%) and preferred equally sh...
I am happy to announce that I passed the test. I am referring to the geriatrics examination given by the American Board of Internal Medicine (ABIM). This means that I am recertified as a Board Certified Specialist in Geriatric Medicine. Recertification is required every 10 years, and this was the third time I succeeded. You would think it gets easier each time, but the opposite is true. New drugs, new side effects, new theories of aging, and new statistics had me studying two hours each morning for a good five weeks prior to the exam. The test itself was a full day, with subject matter that co...
Advanced dementia (AD) patients transition between the home/long term care facility and the hospital whenever there is a crisis, especially towards the end of life (EOL). Coordinated approaches to care in the form of an integrated palliative homecare service may enhance access to support services which would help manage their symptoms at home, thus improving their quality of life (QoL) and alleviating caregiver burden.