Jacobs Journal of Psychiatry and Behavioural Science
Palliative Issues in Dementia Care
Published on: 2018-07-18
Palliative care is appropriate for people with a progressive degenerative dementia because there is nothing available to cure it or to prevent its progression. In the early stages, the palliative care should include support of the care partners and help with formulation of advance care planning, because the person with dementia still have decision making capacity for complex problems. This planning should take into consideration clinical evidence about benefits and burdens of aggressive medical interventions: cardiopulmonary resuscitation, transfer to an acute care setting, tube feeding, and the use of antibiotics for treatment of generalized infections. In moderate and severe dementia, most persons develop behavioral symptoms that require effective management because their treatment is as important as management of pain in persons with cancer. The most common symptoms are apathy, agitation and aggression, and they should be treated with non-pharmacological strategies. Strategies used for agitation and aggression are different: meaningful activities for agitation and improvement in communication in aggression. Changing method of care may be also useful to prevent rejection of care, which may escalate into reactive aggression. Important role of depression in development of agitation and aggression should be also considered. Maintaining quality of life in terminal dementia requires specialized programming because these persons cannot participate in the usual activities. Group activities in pleasant environment, which include loving touch (e.g., Namaste Care), not only increase quality of life but also decreases rejection of care that may escalate into aggression.