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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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