1 / 24

Dementia and Palliative Care

Dementia and Palliative Care. Care at the end of life for patients with dementia Regina Mc Quillan, Palliative Medicine Consultant. Dementia in Ireland. 38,000 people with dementia in Ireland 75% living at home, many without formal diagnosis 50% of care provided by family

tamra
Download Presentation

Dementia and Palliative Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dementia andPalliative Care Care at the end of life for patients with dementia Regina Mc Quillan, Palliative Medicine Consultant

  2. Dementia in Ireland • 38,000 people with dementia in Ireland • 75% living at home, many without formal diagnosis • 50% of care provided by family Alzheimer’s Society of Ireland; National Economic and Social Forum

  3. Dementia • A progressive fatal illness • Live with illness for years, not months • Patients live with it • Family live with it • Carers live with it • Adaptation to changes by patient, family and carer

  4. Adaptation to changes

  5. Information • What is happening? • What is the diagnosis? • What are the likely changes in next months, years?

  6. Appropriate equipment • Access to OT and physiotherapy assessment

  7. Practical help • Home-help • Carer at home

  8. Specialist help • Dementia specialist • Psychiatry of Old Age • Care of the Elderly • Specialist Palliative Care

  9. End of life-Last year of life • Difficulty prognosticating • General decline over months/years • Acute episodes with recovery, but maybe not to premorbid level

  10. Gold Standard Framework Prognostic Indicators for Dementia www.goldstandardsframework.nhs.uk

  11. GSF Dementia-general principles • Multiple comorbidities • Karnofsky Performance Status <50 • General physical decline • Weight loss >10% • Albumin <25g/l

  12. GSF Dementia-primary indicators • Assistance to walk • Double incontinence • No verbal communication • Cannot dress unaided • Barthel<3

  13. GSF Dementia-secondary indicators • Pyleonephritis/UTI • Pressure sores grade III/IV • Recurrent fevers • Reduced oral intake • Aspiration pneumonia

  14. What to do?

  15. Advance Care Planning • What does the patient want? • What does the family believe the patient would want? (not just what the family wants) • What to health care professionals believe is clinically appropriate?

  16. Advance Care Planning A discussion, a process Not a tick box exercise Often not considered in dementia when patient still competent Not legally binding Needs review as patient condition changes, including if patient stabilizes Requires patient/family education re nature of dementia

  17. Physician Orders for Life Sustaining Treatment (POLST) • CPR • Comfort measures only • Limited additional measures eg oral antibiotics, iv antibiotics, parenteral fluids • Full treatment including ICU etc

  18. Beaumont Pilot Project • Based on POLST • No proxy decision maker role in Ireland • Anticipatory prescribing for potential symptoms

  19. Specific Problems

  20. Symptom management • Assessment- patient report, patient history, patient observation including behaviour changes, assessment tools-4 point verbal rating scale • Treatment-may be best guess, if assessment not clear • Evaluation of intervention-as part of assessment, and to see value of treatment

  21. Symptom assessment tools • Four point verbal rating scale is the best • Abbey Pain Scale www.cityofhope.com

  22. Feeding • Anorexia • Dysphagia • Weight loss Part of the natural history of dementia

  23. Artificial feeding • No evidence of benefit of quality or quantity of life

  24. End of life care in dementia • A progressive illness • Family role as ‘voice’ for patient • Family/patient education • Staff education • Staff networking-OT, physio, psychiatry, specialist palliative care, spiritual care • Avoid the ‘bank holiday Friday’ crises

More Related