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[Palliative care for patients with advanced dementia: Evidence-based practice replaced by values-based practice]
1Pflegezentrum Spital Limmattal, Urdorferstr. 100, 8952 Schlieren, Switzerland. roland.kunz@spital-limmattal.ch
Zeitschrift Fur Gerontologie Und Geriatrie
|October 28, 2003
Summary
Evidence-based guidelines are lacking for advanced dementia care. Prioritizing patient quality of life, pain management, and informed feeding decisions is crucial for ethical and effective palliative care.
Area of Science:
- Gerontology
- Palliative Care
- Neurology
Context:
- Advanced dementia care lacks evidence-based guidelines.
- Individual values and quality of life should guide interventions.
- Palliative care emphasizes symptom control and suffering relief.
Purpose:
- To highlight the need for improved decision-making tools in advanced dementia.
- To discuss challenges in pain assessment and feeding.
- To emphasize patient dignity and quality of life.
Summary:
- Pain assessment in non-communicative dementia patients requires specialized tools (e.g., Doloplus, ECPA) as standard methods fail.
- Current pain management and oral feeding support are insufficient.
- Tube feeding lacks evidence for preventing aspiration or prolonging life, and artificial feeding cannot replace the function of oral intake.
Impact:
- Improved pain assessment and management strategies are needed for advanced dementia patients.
- Ethical considerations regarding artificial feeding must prioritize patient will, dignity, and quality of life over family feelings.
- This research underscores the necessity of developing comprehensive guidelines for end-of-life care in advanced dementia.