Do we really need palliative care for severe dementia patients?

Department of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia and Geriatric Research Group, Brescia, Italy.
Age and Ageing (Impact Factor: 3.82). 10/2007; 36(5):584-7. DOI: 10.1093/ageing/afm035
Source: PubMed
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    ABSTRACT: In most elderly people, the final-terminal-phase of life is characterized by permanent dependency and a complete inability to perform activities of daily living. Treatment targets usually switch from rehabilitation to palliation. However, the prevalence of the clinical judgment "last phase of life" and its association with in-hospital death is unknown in geriatric patients. We retrospectively analyzed GEMIDAS data from two geriatric units. Patients without cancer and an in-hospital stay of at least 1 week were included in our study. Prevalence of the terminal phase of life was clinically assessed according to the proposals made by M. Gillick. This clinical judgment was pronounced by the geriatric team after a stay in the hospital of at least 1 week. The clinical judgment took into account all available assessment parameters, as well as the impact of a geriatric treatment trial. In addition, the association between the clinical judgment and the risk of in-hospital mortality was analyzed. Records from 2,433 (56%) patients in hospital A and from 1,912 (44%) patients in hospital B were analyzed. The frequency of a terminal phase of life was 30% and 9% (p<0.01), respectively. The frequency depended on the manner of admission to the hospital. In both hospitals, mortality was significantly higher in terminal patients (27% and 37%) than in other patients (0-8% and 0-6%). In both hospitals, the risk of in-hospital mortality was significantly associated with the clinical judgment (OR 3.1 and 2.7), heart failure (OR 2.2 and 2.1), and dementia (OR 2.0 and 1.8). Age, residency in a nursing home, and the Barthel Index on admission were all without relevant impact. The frequency of the clinical construct "terminal phase of life" varies in geriatric units between 9% and 30%. This clinical construct is significantly associated with increased in-hospital mortality. Therefore, this construct possesses external validity. Further studies are needed in order to assess the significance of such a clinical judgment, the associations with clinical burdens of symptoms, and the supply structure required to cover the needs of patients and their families.
    Zeitschrift für Gerontologie + Geriatrie 04/2011; 44(5):329-35. · 0.74 Impact Factor
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    ABSTRACT: i ABSTRACT This thesis explores nurses' conceptualisation of dementia and discusses the relationship between these understandings and nursing practice. Using the reflexive sociological approach of French scholar Pierre Bourdieu, the study seeks to advance practice through the enhancement of theoretical understandings. Data were collected in a range of inpatient clinical areas in Scotland using focus groups, individual interviews and observation. A range of nurses contributed, reflecting views and understandings from inpatient areas run by both general medical and mental health services. Nurses were found to conceptualise dementia in four main ways; as a disease, as a memory problem, as confusion and finally as a journey. These four conceptualisations are addressed in turn and the ways in which they inform and relate to practice are discussed. Limitations to practice arising from the nurses conceptualisations are also highlighted. Dominant approaches to care are outlined throughout the thesis, with the medical model, individualised care, person-centred dementia care and palliative care all being discussed in light of the nurses' understandings of dementia.
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    ABSTRACT: This review assesses the current opinion towards early palliative care in neurology and discusses the existing evidence base. A comprehensive literature search resulted in 714 publications with 53 being directly relevant to the scope of this review. The current literature reflects primarily expert opinion and describes a growing interest in the early introduction of palliative principles into neurological care. Early initiation of palliative interventions has the potential to improve quality of life, enhance symptom management and assist in advance care planning. Further data is required to determine whether this shift in philosophy has a positive impact on patient care.
    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 06/2009; 36(3):296-302. · 1.33 Impact Factor

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