67 year old female, this one was very difficult. Client had | Figure 1

pacho

Registered Nurse

67 year old female, this one was very difficult. Client had a history of depression, but primary diagnosis was vascular dementia making placement under LPS WIC 5150 hold (psych hold) virtually impossible, tying my hands.

Palliative care is used a lot with people with cancer but is not used much for people with advanced dementia. We found nine suitable studies that involved 2122 people. Two studies were carried out in hospitals and seven in nursing homes or long‐term care facilities.

Key results

Six studies tested changes to the way care for people with advanced dementia is organised and delivered. Five studies found that these changes may increase comfort in dying, but problems with study design and differences in outcome between studies make this result very uncertain, so it is possible that overall they may make little or no difference. Changes to care organisation and delivery may also mean that people with advanced dementia are more likely to have a plan in place for their care, but this result came from only one study, and again we are very uncertain about it. Making changes to how care is organised and delivered probably has no effect on the use of non‐palliative approaches to care and may have little or no effect on whether discussions take place between people with dementia, their family caregiver, and their doctors and nurses on the nature and type of palliative care they would like to receive.

Two studies found that helping the person with dementia and their family to plan ahead probably makes it more likely that the person with dementia has a written document giving instructions on the types of treatments they want to receive (an advance care plan), and that they have spoken to their doctors and nurses about what they would like from their care. One of these studies also found that advance planning may mean that there is slightly more agreement between what the doctors and nurses believe are the care goals and what the person with dementia believes. However, based on one study, planning may not impact on how well family caregivers feel the person with dementia’s symptoms are managed.

Conclusions

Overall, the research done so far does not give a clear picture about how palliative care can best be used to help either the person with advanced dementia or their family. Little research has been done about people with advanced dementia, often because of ethical concerns. However, although it is hard to do research with people with dementia, more well‐designed studies are required to work out how palliative care can be used best in this special population.