Related Experiment Videos
Palliative care in advanced dementia: a randomized controlled trial and descriptive analysis
J C Ahronheim1, R S Morrison, J Morris
1Eileen E. Anderson Section of Geriatrics, Saint Vincent's Hospital and Medical Center, New York, New York 10011, USA. jahronheim@saintvincentsnyc.org
Journal of Palliative Medicine
|April 30, 2005
Summary
Palliative care interventions had limited impact on advanced dementia patients in hospitals. Barriers like prognostic uncertainty and tube feeding perceptions hindered care adjustments, necessitating a reevaluation of treatment approaches.
Area of Science:
- Geriatrics
- Palliative Care
- Neurology
Background:
- Advanced dementia patients are underrepresented in hospice care.
- Palliative care is suitable for various settings, including acute hospitals.
Purpose of the Study:
- To evaluate the effectiveness of a palliative care team intervention for hospitalized patients with advanced dementia.
Main Methods:
- A randomized controlled trial was conducted with advanced dementia patients (Functional Assessment Staging Tool [FAST] stage 6d-7f) hospitalized for acute illness.
- Intervention group received palliative care team recommendations for comfort; control group received usual care.
Main Results:
- Palliative care plans were more common in the intervention group (23% vs. 4%), often at discharge.
- Fewer intervention patients received intravenous therapy (66% vs. 81%).
- High rates of interventions like antibiotics (75%) and feeding tubes (44%) were observed.
Conclusions:
- Influencing care for advanced dementia patients in hospitals proved challenging.
- Barriers include prognostic uncertainty, comfort assessment difficulties, and tube feeding perceptions.
- Revisiting treatment strategies and early goal setting before hospitalization is crucial.
Related Concept Videos
01:25Continuing Care
Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
01:26Alzheimer's Disease: Overview
Alzheimer's Disease (AD) is a continually advancing neurodegenerative disorder, distinguished by escalating memory loss, cognitive dysfunction, and dementia. The disease unfolds in three stages: preclinical, mild cognitive impairment (MCI), and dementia. Its onset is insidious, and the progression gradual, with the cause not well explained by other disorders.
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ and tau...
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ and tau...
01:22Alzheimer's Disease: Treatment
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
01:30Dementia
Dementia is a collective term for cognitive disorders primarily affecting memory, thinking, and reasoning. It is not a specific disease but a syndrome, with Alzheimer's disease being the most common cause, accounting for approximately 60-80% of cases. Other types include vascular dementia, Lewy body dementia, and frontotemporal dementia. Dementia affects millions worldwide, particularly older adults, though it is not a normal part of aging.
The progression of dementia is generally gradual.
The progression of dementia is generally gradual.
01:29Alzheimer Disease l: Introduction
Alzheimer disease is a chronic, progressive, and irreversible neurodegenerative disorder and the most common cause of dementia in older adults. It leads to gradual neuronal loss, causing cognitive decline, behavioral changes, and loss of functional independence.Risk Factors and EtiologyThe disease is multifactorial. Age is the strongest risk factor, with prevalence doubling every 5 years after age 65. Genetic factors include mutations in genes such as APP, PSEN1, and PSEN2, which are associated...