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A systematic review of the integration of palliative care in dementia management

Published online by Cambridge University Press:  18 November 2019

Helen Senderovich Open the ORCID record for Helen Senderovich [Opens in a new window]  and
Sivarajini Retnasothie
Helen Senderovich*
Affiliation:
Department of Family and Community Medicine, Division of Geriatrics & Palliative Care & Pain Medicine, Baycrest, Toronto, ON, Canada M6A 2E1
Sivarajini Retnasothie
Affiliation:
Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
*
Author for correspondence: Helen Senderovich, Department of Family and Community Medicine, Division of Geriatrics & Palliative Care & Pain Medicine, Baycrest, 3560 Bathurst Street, Toronto, ON, CanadaM6A 2E1. E-mail: hsenderovich@baycrest.org
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Abstract

Objective

Dementia is a progressive illness with a complex biopsychosocial constellation of symptoms faced by millions of individuals and families worldwide. Palliative care teams have specialized in symptom management and end-of-life care for decades; however, the role of palliative care in dementia management is not yet well elucidated. The aim of this systematic review was to understand the impact of palliative care in dementia management.

Method

This systematic review was conducted using a prospective study protocol. Medline and PubMed were searched from January 1, 1998 to October 2017. Eligible studies included single-blind cluster, two-arm parallel cluster, or unblinded randomized controlled trials (RCTs), observational studies, retrospective cohort studies, cross-sectional studies, concurrent mixed methods study, qualitative study, and Delphi studies.

Results

Four key themes were identified in this review: goals of care and end-of-life conversations, symptom management, emergency room visits, and prescribing behavior. In each domain, palliative care consultation either showed benefit or was postulated to have benefit if implemented.

Significance of results

Although the literature to support or refute thematic conclusions is not large, there was a trend toward patient care benefit across several domains. Large RCTs with longer follow-up across different settings should be undertaken to solidify the themes and trends outlined in this review. Understanding the views of healthcare providers including referral sources (i.e., general practitioners and specialists) through qualitative research could optimize palliative care referrals, implement palliative care recommendations, and improve a targeted palliative care education curriculum.

Keywords

DementiaNeurodegenerativePalliative carePatient care planningReferral and consultation
Type
Review Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 495 - 506
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Copyright
Copyright © Cambridge University Press 2019

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References

REFERENCES

Agar, M, Luckett, T, Luscombe, G, et al. (2017) Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial. PLoS One 12(8), e0181020.CrossRefGoogle ScholarPubMed
Alzheimer Society of Canada (2018) Dementia Numbers in Canada. Available at: http://alzheimer.ca (accessed 4 April 2018).Google Scholar
Araw, M, Kozikowski, A, Sison, C, et al. (2015) Does a palliative care consult decrease the cost of caring for hospitalized patients with dementia? Palliative and Supportive Care 13(6), 1535–1540.CrossRefGoogle ScholarPubMed
Brown, MA, Sampson, EL, Jones, L, et al. (2013) Prognostic indicators of 6-month mortality in elderly people with advanced dementia: A systematic review. Palliative Medicine 27(5), 389–400.CrossRefGoogle ScholarPubMed
Callaway, MV, Connor, SR and Foley, KM (2018) World health organization public health model: A roadmap for palliative care development. Journal of Pain and Symptom Management 55(2), S6–S13.CrossRefGoogle ScholarPubMed
Downar, J, Goldman, R, Pinto, R, et al. (2017) The “surprise question” for predicting death in seriously ill patients: A systematic review and meta-analysis. CMAJ 189(13), E484–E493.CrossRefGoogle ScholarPubMed
Hanson, L, Zimmerman, S, Song, M, et al. (2017) Effect of the goals of care intervention for advanced dementia: A randomized clinical trial. JAMA Internal Medicine 177(1), 24–31.CrossRefGoogle ScholarPubMed
Hendriks, S, Smalbrugge, M, Galindo-Garre, F, et al. (2015) From admission to death: Prevalence and course of pain, agitation, and shortness of breath and treatment of these symptoms in nursing home residents with dementia. Journal of the American Medical Directors Association 16(6), 45–81.CrossRefGoogle ScholarPubMed
Hendriks, S, Smalbrugge, M, Hertogh, C, et al. (2017) Changes in care goals and treatment orders around the occurrence of health problems and hospital transfers in dementia: A prospective study. Journal of American Geriatrics Society 65(4), 769–776.CrossRefGoogle ScholarPubMed
Holmes, H, Sachs, G, Shega, J, et al. (2008) Integrating palliative medicine into the care of persons with advanced dementia: Identifying appropriate medication use. Journal of the American Geriatrics Society 56(7), 1306–1311.CrossRefGoogle ScholarPubMed
Jones, L, Candy, B, Davis, S, et al. (2016) Development of a model for integrated care at the end of life in advanced dementia. Palliative Medicine 30(3), 279–295.CrossRefGoogle Scholar
Lau, L and Brodney, M (2018) Alzheimer's disease, 2nd ed. New York: Springer.Google Scholar
Lee, R, Bamford, C, Poole, M, et al. (2017) End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice. PLoS One 12(6), e0179455.Google ScholarPubMed
Linklater, G, Lawton, S, Fielding, S, et al. (2012) Introducing the Palliative Performance Scale to clinicians: The Grampian experience. BMJ Supportive & Palliative Care 2, 121–126.CrossRefGoogle ScholarPubMed
Manabe, T, Mizukami, K, Akatsu, H, et al. (2017) Factors associated with pneumonia-caused death in older adults with autopsy-confirmed dementia. Internal Medicine 56(8), 907–914.CrossRefGoogle ScholarPubMed
Mitchell, G, Senior, H, Rhee, J, et al. (2018) Using intuition or a formal palliative care needs assessment screening process in general practice to predict death within 12 months: A randomised controlled trial. Palliative Medicine 32(2), 384–394.CrossRefGoogle ScholarPubMed
Murphy, E, Froggatt, K, Connolly, S, et al. (2016) Palliative care interventions in advanced dementia. Cochrane Database of Systematic Review. doi:10.1002/14651858.CD011513.pub2.CrossRefGoogle ScholarPubMed
Murray, SA, Kendall, M, Boyd, K, et al. (2005) Illness trajectories and palliative care. British Medical Journal 330(7498), 1007–1011.CrossRefGoogle ScholarPubMed
Passmore, M, Ho, A and Gallagher, R (2012) Behavioral and psychological symptoms in moderate to severe Alzheimer's disease: A palliative care approach emphasizing recognition of personhood and preservation of dignity. Journal of Alzheimer's Disease 29(1), 1–13.CrossRefGoogle ScholarPubMed
Pinzon, L, Claus, M, Perrar, K, et al. (2013) Dying with dementia: Symptom burden, quality of care and place of death. Deutsches Ärzteblatt International 110(12), 195–202.Google ScholarPubMed
Powers, B and Watson, N (2008) Meaning and practice of palliative care for nursing home residents with dementia at end of life. American Journal of Alzheimer's Disease and Other Dementias 23(4), 319.CrossRefGoogle ScholarPubMed
Rochon, P and Gurwitz, J (1995) Drug therapy. Lancet 346(8966), 32–36.CrossRefGoogle ScholarPubMed
Rochon, P and Gurwitz, J (1997) Optimising drug treatment for elderly people: The prescribing cascade. British Medical Journal 315(7115), 1096–1099.CrossRefGoogle ScholarPubMed
Rosenwax, L, Spilsbury, K, Arendts, G, et al. (2015) Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study. Palliative Medicine 29(8), 727–736.CrossRefGoogle ScholarPubMed
Rosler, A, Pfeil, S, Lessmann, H, et al. (2015) Dysphagia in dementia: Influence of dementia severity and food texture on the prevalence of aspiration and latency to swallow in hospitalized geriatric patients. Journal of the American Medical Directors Association 16(8), 697–701.CrossRefGoogle ScholarPubMed
Sampson, E, Jones, L, Thune-Boyle, I, et al. (2011) Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention. Palliative Medicine 25(3), 197–209.CrossRefGoogle ScholarPubMed
Soares, L, Japiassu, A, Gomes, L, et al. (2018) Prevalence and intensity of dyspnea, pain, and agitation among people dying with late stage dementia compared with people dying with advanced cancer: A single-center preliminary study in Brazil. Annals of Palliative Medicine. doi:10.21037/apm.2018.05.06.CrossRefGoogle ScholarPubMed
Sternberg, S, Bentur, N and Shuldiner, J (2014) Quality of care of older people living with advanced dementia in the community in Israel. Journal of the American Geriatrics Society 62(2), 269–275.CrossRefGoogle ScholarPubMed
Teno, JM, Lynn, J, Phillips, RS, et al. (1994) Do formal advance directives affect resuscitation decisions and the use of resources for seriously ill patients? Journal of Clinical Ethics 5(1), 23–30.Google ScholarPubMed
The Gold Standards Framework (2010) Proactive Identification Guidance (PIG) The National GSF Centre's Guidance for Clinicians to Support Earlier Identification of Patients Nearing the End of Life Leading to Improved Proactive Person-Centred Care National Policy Support for Earlier Identification. Available at: www.goldstandardsframework.org.uk (accessed 24 August 2018).Google Scholar
Van Der Steen, J, Radbruch, L, De Boer, M, et al. (2016) Achieving consensus and controversy around applicability of palliative care to dementia. International Psychogeriatric 28(1), 133–145.CrossRefGoogle Scholar
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