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Dementia
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Dementia is not a single specific disease but rather a range of diseases characterised by impairment of brain functions resulting in restrictions in language, memory, perception, personality, cognitive skills and activities of daily living. The most common type of dementia is Alzheimer’s disease. There is currently no cure for dementia and it is the greatest single contributor to burden of disease. Because dementia is a disabling health condition a large proportion of people with advanced dementia require full-time care and live in a residential aged care facility. An alternate to residential aged care are the Extended Aged Care at Home Dementia Packages (EACH-D). [1]

Issues common to people with dementia who require palliative care

Dementia is a terminal disease and a palliative approach should be considered from diagnosis. Issues concerning palliative care for people with dementia include:

  • Decision making, communicating and advance care planning to ensure that the wishes of the person are identified and that appropriate ways of interacting are maintained. 
  • Pain assessment for people unable to verbalise pain. There are a number of tools that have been identified for this population.
  • Treatment decisions as the disease progresses such as tube feeding or antibiotic use.
  • Recognising issues and concerns of carers and family.

Many people with dementia have existing co-morbidities. They may not die from the dementia, but (for example) from heart disease or a stroke.

Dementia is used to describe symptoms of a large group of illnesses that contribute to a decline in intellectual functioning. Alzheimer’s disease is the most common form of dementia. [2] However, symptoms can be similar to other conditions. Diagnosis of the disease and of subsequent symptoms can be important as some conditions such as delirium and depression could be treatable. 

Several recent reviews have suggested that a palliative approach from diagnosis could be beneficial because it addresses people's physical and emotional needs as well as the needs of their families and carers. [3-4] However, there are issues around how such an approach would be delivered and practical considerations around identification of specific palliative care needs. [5-8]

Policies and resources

Websites

Related Care Search pages

Pain
Advance Care Planning

References

  1. Australian Institute of Health and Welfare. Older Australia at a glance: 4th edition [Internet]. 2007; AIHW cat. no. AGE 52.
  2. Zanni GR, Wick JY. Differentiating dementias in long-term care patients. Consult Pharm. 2007 Jan;22(1):14-6, 18, 21-8.
  3. Birch D, Draper J. A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia. J Clin Nurs. 2008 May;17(9):1144-63.
  4. Sampson EL, Ritchie CW, Lai R, Raven PW, Blanchard MR. A systematic review of the scientific evidence for the efficacy of a palliative approach in advanced dementia. Int Psychogeriatr. 2005 Mar;17(1):31-40.
  5. Roger KS. A literature review of palliative care, end of life and dementia. Palliat Support Care. 2006 Sep;4(3):295-303.
  6. Park J, Castellanos-Brown K, Belcher J. A review of observational pain scales in nonverbal elderly with cognitive impairments. Res Soc Work Pract. 2010 Nov;20(6):651-4.
  7. Parsons C, Hughes CM, Passmore AP, Lapane KL. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying? Drugs Aging. 2010 Jun 1;27(6):435-49.
  8. van der Steen JT. Dying with dementia: what we know after more than a decade of research. J Alzheimers Dis. 2010;22(1):37-55.

Last updated 02 September 2013*