Dementia and frailty

2019 ◽  
pp. 579-618
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Advanced Disease ◽  
Psychological Symptoms ◽  
Management Strategies ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
The Uk ◽  
End Stage

This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.

scholarly journals Before writing that script: use of antipsychotic medication in patients with dementia in a CMHTOA

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S96-S96
Author(s):  
Adaora Obiekezie ◽  
Roohi Afshan ◽  
Jack Healy
Keyword(s):  
Antipsychotic Medication ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Diagnosis Of Dementia ◽  
Independent Review ◽  
The Common ◽  
The Uk ◽  
Current Guidelines

AimsA 2009 independent review commissioned by the UK government to review the use of antipsychotic medication in patients diagnosed with dementia produced the Time for Action report, often referred to as the Banerjee Report. It highlighted the common practise of using antipsychotics in the treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) and the clinical issues this could raise especially when these medications were not being regularly reviewed. The audti was therefore carried out to determine whether patinets with BPSD in a Community Mental Health Team for Older adults (CMHTOA) in Mid Surrey, who had been diagnosed with BPSD, were being adequately assessed and managed in line with the current guidelines.MethodPatients with a diagnosis of dementia open to one of three teams in the CMHTOA during the months of October and November 2019 were identified, those being prescribed antipsychotic medication were selected and data from their electronic records collected and analysed to determine if clinicians: a) identified and documented the target behaviours, b) carried out a structured assessment using an ABC chart before commencing medication, c) reviewed the antipsychotic medication 6 weeks after it was commenced.ResultOf the 87 patients with a diagnosis of Dementia from October to November 2019, 18 were on antipsychotic medication. 100% of these had target behaviours identified and clearly documented, a sixth had a structured assessment prior to starting medication and 61% had been reviewed after the first 6 weeks of starting antipsychotics.ConclusionThe findings showed that a good proprotion of patients did not have the required structured assessment before commencement of treatment and that more needed to be done by way of improving regular reviews after antipsychotic treatment is commenced.

Ethics and the law involving the elderly

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Informed Consent ◽  
The Elderly ◽  
Outcome Data ◽  
Ethical Principles ◽  
Assisted Death ◽  
The Uk

The role of ethics in the care of the elderly is discussed, and some of the aspects of importance to anaesthesia are reviewed. Ethical principles are commonly viewed as either consequential, where the risk/benefit balance between necessary harm (surgery) provides improved quality of life, or deontological, where it is simply the action that is judged and not the outcome. The lack of individualized outcome data is identified as a major issue for the consequential process. Consent for surgery (and anaesthesia) is described in the context of the UK, but it is applicable worldwide. The validity of informed consent is reviewed against the criteria of competence, lack of duress, and appropriately provided information. The capacity to give consent and the use of legal alternatives such as health attorneys is detailed. Finally, the debate on excellent palliative care rather than assisted death is reviewed.

PTH-125 A national survey of palliative care in end stage liver disease in the UK

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A463.1-A463
Author(s):  
V Vickerstaff ◽  
J Low ◽  
S Davis ◽  
J Bichard ◽  
L Greenslade ◽  
...  
Keyword(s):  
Palliative Care ◽  
Liver Disease ◽  
National Survey ◽  
End Stage Liver Disease ◽  
The Uk ◽  
End Stage

scholarly journals Multidisciplinary Team-Based Palliative Care for Heart Failure and Food Intake at the End of Life

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2387
Author(s):  
Tatsuhiro Shibata ◽  
Kazutoshi Mawatari ◽  
Naoko Nakashima ◽  
Koutatsu Shimozono ◽  
Kouko Ushijima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Food Intake ◽  
End Of Life ◽  
Psychological Symptoms ◽  
Symptom Relief ◽  
Artificial Nutrition ◽  
End Stage ◽  
The Impact

Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life.

Impact of the caregiver burden on the effectiveness of a home-based palliative care program: A mediation analysis

2019 ◽  
Vol 18 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Angela J. Pereira-Morales ◽  
Luis Enrique Valencia ◽  
Luis Rojas
Keyword(s):  
Palliative Care ◽  
Caregiver Burden ◽  
Psychological Symptoms ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
High Prevalence ◽  
The Relationship ◽  
Significant Mediator

AbstractObjectiveThe growing aging population and the high prevalence of several concomitant chronic diseases have contributed to the elevated rates of caregiver burden and suffering in patients. In turn, intending to relieve unnecessary pain in patients, there has been a rapid growth of outpatient palliative care programs. However, little has been studied about caregiver burden as a relevant factor potentially affecting the effectiveness of these programs. This study aimed to determine the extent of caregiver burden as a possible mediator on the effectiveness of a home-based palliative care program.MethodSixty-six palliative patients (56% women; mean age + SD = 71, 6 ± 17.7) and their caregivers were assessed with measures for physical, emotional, and psychological symptoms before and 1 month after the start of a home-based palliative care program.ResultsThe association between caregiver burden and palliative outcomes was corroborated with a categorical regression model (p < 0.01). Caregiver burden was found to be a significant mediator in the relationship between outcome measures for palliative care at baseline and after 1 month of enrollment in the program.Significance of resultsTo our knowledge, this is the first study to assess the role of caregiver burden in the effectiveness of a home-based palliative care program. Although further work is required, the results indicate that a patient-focused intervention does not have the same beneficial effect if the caregiver burden is not addressed. Future home-based palliative care programs should focus on caregivers as well as patients, with particular attention to psychosocial intervention on caregivers.

Access to Palliative Care for Patients Undergoing Mechanical Ventilation With Idiopathic Pulmonary Fibrosis in the United States

2017 ◽  
Vol 35 (3) ◽  
pp. 492-496 ◽  
Author(s):  
Barret Rush ◽  
Landon Berger ◽  
Leo Anthony Celi
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Hospital Admissions ◽  
The United States ◽  
Do Not Resuscitate ◽  
Mechanically Ventilated ◽  
Inpatient Hospitalizations ◽  
End Stage

Objective: The utilization of palliative care (PC) in patients with end-stage idiopathic pulmonary fibrosis (IPF) is not well understood. Methods: The Nationwide Inpatient Sample (NIS) was utilized to examine the use of PC in mechanically ventilated (MV) patients with IPF. The NIS captures 20% of all US inpatient hospitalizations and is weighted to estimate 95% of all inpatient care. Results: A total of 55 208 382 hospital admissions from the 2006 to 2012 NIS samples were examined. There were 21 808 patients identified with pulmonary fibrosis, of which 3166 underwent mechanical ventilation and were included in the analysis. Of the 3166 patients in the main cohort, 408 (12.9%) had an encounter with PC, whereas 2758 (87.1%) did not. After multivariate logistic regression modeling, variables associated with increased access to PC referral were age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03, P < .01), treatment in an urban teaching hospital (OR: 1.49, 95% CI: 1.27-3.58, P < .01), and do-not-resuscitate status (OR: 9.86, 95% CI: 7.48-13.00, P < .01). Factors associated with less access to PC were Hispanic race (OR: 0.64, 95% CI: 0.41-0.99, P = .04) and missing race (OR: 0.52, 95% CI: 0.34-0.79, P < .01), with white race serving as the reference. The use of PC has increased almost 10-fold from 2.3% in 2006 to 21.6% in 2012 ( P < .01). Conclusion: The utilization of PC in patients with IPF who undergo MV has increased dramatically between 2006 and 2012.

scholarly journals End-stage organ disease–Healthcare utilisation: Impact of palliative medicine

2021 ◽  
pp. bmjspcare-2021-003288
Author(s):  
Allyn Hum ◽  
Chun Wei Yap ◽  
Mervyn Yong Hwang Koh
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Healthcare Utilisation ◽  
Exact Matching ◽  
Inpatient Hospital ◽  
Ed Visits ◽  
End Stage

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.MethodsPatients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.ResultsPatients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (p all <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).ConclusionPalliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.

scholarly journals Individuals’ Decision to Disclose a Diagnosis of Dementia and the Development of an Online Empowerment Intervention

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 589-590
Author(s):  
Mauricio Molinari Ulate ◽  
Jem Bhatt ◽  
Jennifer Lynch ◽  
Katrina Scior ◽  
Georgina Charlesworth ◽  
...  
Keyword(s):  
Public Involvement ◽  
Adverse Reactions ◽  
Psychosocial Health ◽  
Patient And Public Involvement ◽  
Dementia Diagnosis ◽  
Factors Influencing ◽  
People With Dementia ◽  
Complex Process ◽  
Diagnosis Of Dementia

Abstract Learning to live with a diagnosis of dementia is a complex process. Many people affected by dementia choose not to disclose the diagnosis to others and avoid social activities due to fear of others’ adverse reactions. This in turn can limit their social participation and negatively affect their psychosocial health. A systematic review explored factors influencing the decision to disclose or conceal a dementia diagnosis to one’s social network, including individuals’ attitudes and experiences regarding this decision. The sixteen studies included reveal the complexity of this decision. Findings highlight the role of stigma and individuals’ wishes to remain ‘normal’, but also the need of explaining what has changed. Results were further discussed with people with dementia and informal caregivers as part of patient and public involvement. End users expressed their attitudes, needs, and wishes towards the design of an online empowerment intervention supporting disclosure decision-making in people affected by dementia.

Potential role of extracellular vesicles in the pathophysiology of glomerular diseases

2020 ◽  
Vol 134 (20) ◽  
pp. 2741-2754
Author(s):  
Xia-Qing Li ◽  
Lilach O. Lerman ◽  
Yu Meng
Keyword(s):  
Extracellular Vesicles ◽  
Biological Fluids ◽  
Management Strategies ◽  
Renal Diseases ◽  
Future Research ◽  
Target Cells ◽  
Glomerular Diseases ◽  
Stage Renal Disease ◽  
End Stage

Abstract Extracellular vesicles (EVs) are membrane-bound vesicles released by most cells and are found in diverse biological fluids. The release of EVs provides a new mechanism for intercellular communication, allowing cells to transfer their functional cargoes to target cells. Glomerular diseases account for a large proportion of end-stage renal disease (ESRD) worldwide. In recent years, an increasing number of research groups have focused their effort on identifying the functional role of EVs in renal diseases. However, the involvement of EVs in the pathophysiology of glomerular diseases has not been comprehensively described and discussed. In this review, we first briefly introduce the characteristics of EVs. Then, we describe the involvement of EVs in the mechanisms underlying glomerular diseases, including immunological and fibrotic processes. We also discuss what functions EVs derived from different kidney cells have in glomerular diseases and how EVs exert their effects through different signaling pathways. Furthermore, we summarize recent advances in the knowledge of EV involvement in the pathogenesis of various glomerular diseases. Finally, we propose future research directions for identifying better management strategies for glomerular diseases.

Symptom Assessment

2018 ◽  
Author(s):  
Marvin Omar Delgado Guay
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Advanced Disease ◽  
Psychological Symptoms ◽  
Symptom Assessment ◽  
Optimal Management ◽  
Disease Experience ◽  
Key Aspects ◽  
Routine Assessment

Patients with advanced disease experience severe physical and psychological symptoms which are often underdiagnosed and often addressed only when severe and debilitating. Recent studies have shown that routine assessment of symptoms is significantly associated with improvement of quality of life and extending survival. The optimal delivery of quality palliative care involves improving quality of life by impeccable assessment of physical and psychosocial symptoms. Routine screening of symptoms using validated tools often results in thorough assessment of the significant symptoms and prompt and optimal management of symptom distress. This chapter reviews the key aspects involved in screening and assessment of symptoms.

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