Palliative Care In Dementia
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Introduction[edit | edit source]
Dementia and It's Progression[edit | edit source]
Dementia refers to a collection of symptoms that appear when diseases such as Alzheimer's or vascular dementia damage the brain, and not does not considered a normal process with aging. Initially, dementia's impact is mild but may worsens over time, affecting each person differently. The majority of individuals with advanced dementia spend their final days in institutional settings, where they often experience various challenging symptoms and complications[1]. Early stages of dementia is started by cognitive problems with progression and advances stages psychological and physical functions are affected also[2].
In the early stages, cognitive issues are prominent, involving memory, thinking, and behavior, with changes in personality and speech. Early dementia may cause challenges in remembering recent events, focusing, planning, decision-making, language comprehension, and communication. People with dementia might struggle to understand visual information, misjudge distances, or misinterpret patterns.
As dementia progresses to advanced stages, it significantly affects memory, communication, and daily activities. The rate at which symptoms worsen varies based on the type of dementia and is unique to each individual. They may have trouble talking, expressing their selves verbally, instead they can nonverbal communication, difficult in movement and often needing help to get around. They might show their feelings or needs through actions, especially when they're upset or confused. In addition, individuals may not recognize loved ones or remember personal details.[3]
Palliative Care[edit | edit source]
Palliative care is often misunderstood as being relevant only for the elderly or those in the final stages of life with no hope of a cure. However, this perspective is limited and overlooks the broader application and benefits of palliative care. It is a crucial aspect of healthcare for individuals of all ages who are managing serious, chronic illnesses, focusing not just on end-of-life care, but on improving quality of life, managing pain, and providing psychological support. Dismissing it as merely end-of-life care underestimates its potential to enhance the lives of many patients, regardless of their age or stage of illness.
Role of Palliative Care in Dementia Management[edit | edit source]
Palliative care is most impotent and required with advanced dementia, they commonly experience[4]:
- Pain
- Mobility restriction
- Sleep disorders
- Breathing problems along with eating difficulties special in their final year.
- Fear, anxiety, agitation[5].
- Resistance to care.
Patients with dementia specifically progressive condition cannot be left without cure and there is an increase need for palliative care, to help overcome the burdens of their life. Individuals with dementia experience a high burden of symptoms, so palliative care can focus on enhancing quality of life for those with advanced dementia, alleviate symptoms, prevent both under-treatment and excessive, burdensome treatments, and also improve the well-being of caregivers. Despite these needs, people with dementia often receive less palliative care and face significant symptom challenges. The needs for those with advanced dementia differ from those in the earlier stages of the condition. Although there is limited evidence supporting palliative care in dementia, it remains a necessary intervention. The symptoms and burdens of dementia can be similar to those experienced in malignant and chronic diseases[6].
Pain Management and Symptom Control in Dementia[edit | edit source]
Up to 63% of people with dementia complain from pain, specially those with advanced dementia they have the sever pain, pain is a subjective perception[7]and addressed as a common persistent symptoms of dementia. It may be because of arthritis, constipation, or infections. Patients with dementia who reported pain may also have other behavioral and psychiatric symptoms, for example there was found to be a relation between pain and depression[8]. People with dementia may has a memory and communication problems making it hard to express their pain or feelings, in addition, might not be able to say when they're in pain or uncomfortable, which can lead to them crying or getting restless and sometimes, these signs are ignored because they have dementia.
Pain Assessment in Advanced Dementia (PAINAD) scale frequently to assess their pain, this scale include categories like; patterns of breathing, types of vocal sounds, expressions on the face, body gestures, and the ability to be consoled.[9]
Effective pain management for dementia involves personalized plans that are regularly updated. Caregivers' familiarity with the patient aids in accurate pain assessment. Pain treatment in advanced dementia often starts late, and those primarily diagnosed with dementia receive less frequent treatment than others. Also, home care patients might not always receive sufficient pain relief[10]. There are pharmacological and non pharmacological treatments can be uses. In addition to, the common pain medications like paracetamol, NSAIDs, and opioids have side effects, there are non-medical approaches, including massage and relaxation techniques, can alleviate pain. Movement-related pain may need extra medication, and regular, gentle exercise or physiotherapy helps maintain mobility and reduce discomfort[11].
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References[edit | edit source]
- ↑ Eisenmann Y, Golla H, Schmidt H, Voltz R, Perrar KM. Palliative care in advanced dementia. Frontiers in psychiatry. 2020 Jul 21;11:699.
- ↑ Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. Jama. 2003 May 14;289(18):2387-92.
- ↑ Diehl-Schmid J, Riedl L, Rüsing U, Hartmann J, Bertok M, Levin C, Hamann J, Arcand M, Lorenzl S, Feddersen B, Jox RJ. Provision of palliative care for people with advanced dementia. Der Nervenarzt. 2018 May;89:524-9.
- ↑ Koppitz A, Bosshard G, Schuster DH, Hediger H, Imhof L. Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes. Zeitschrift Für Gerontologie und Geriatrie. 2015;48(2):176-83.
- ↑ Vandervoort A, Van den Block L, van der Steen JT, Volicer L, Vander Stichele R, Houttekier D, Deliens L. Nursing home residents dying with dementia in Flanders, Belgium: a nationwide postmortem study on clinical characteristics and quality of dying. Journal of the American Medical Directors Association. 2013 Jul 1;14(7):485-92.
- ↑ Moens K, Higginson IJ, Harding R, Brearley S, Caraceni A, Cohen J, Costantini M, Deliens L, Francke AL, Kaasa S, Linden K. Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. Journal of pain and symptom management. 2014 Oct 1;48(4):660-77.
- ↑ Moens K, Higginson IJ, Harding R, Brearley S, Caraceni A, Cohen J, Costantini M, Deliens L, Francke AL, Kaasa S, Linden K. Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. Journal of pain and symptom management. 2014 Oct 1;48(4):660-77.
- ↑ Sampson EL, Candy B, Davis S, Gola AB, Harrington J, King M, Kupeli N, Leavey G, Moore K, Nazareth I, Omar RZ. Living and dying with advanced dementia: a prospective cohort study of symptoms, service use and care at the end of life. Palliative medicine. 2018 Mar;32(3):668-81.
- ↑ Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association. 2003 Jan 1;4(1):9-15.
- ↑ van Kooten J, Smalbrugge M, van der Wouden JC, Stek ML, Hertogh CM. Prevalence of pain in nursing home residents: the role of dementia stage and dementia subtypes. Journal of the American Medical Directors Association. 2017 Jun 1;18(6):522-7.
- ↑ Schmidt H, Eisenmann Y, Golla H, Voltz R, Perrar KM. Needs of people with advanced dementia in their final phase of life: a multi-perspective qualitative study in nursing homes. Palliative medicine. 2018 Mar;32(3):657-67.
