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Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
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Dying with dementia in long-term care
Philip D Sloane1, Sheryl Zimmerman, Christianna S Williams
1ABT Associates, Durham, North Carolina, USA. psloane@med.unc.edu
The Gerontologist
|January 14, 2009
Summary
Quality of care for dying individuals with dementia in long-term care settings is comparable to those without dementia. Specific areas for improvement in palliative care were identified for persons with dementia.
Area of Science:
- Gerontology
- Palliative Care
- Long-Term Care
Background:
- Understanding end-of-life care experiences in long-term care is crucial.
- Identifying unmet needs for persons with dementia is a priority.
Purpose of the Study:
- To investigate the experiences of persons dying in long-term care.
- To identify potential unmet needs in end-of-life care for individuals with dementia.
Main Methods:
- After-death interviews with staff caring for decedents in nursing homes (NHs) and residential care-assisted living (RC-AL) settings.
- Interviews with family caregivers of decedents with and without dementia.
- Comparison of care quality between cognitively impaired and intact individuals.
Main Results:
- No significant differences in pain, psychosocial status, family involvement, advance care planning, life-prolonging interventions, or hospice use between decedents with and without dementia.
- Dementia decedents experienced fewer hospital deaths, less shortness of breath, more physical restraints, and less frequent emergency service use on the last day of life.
- Dementia decedents in RC-AL settings had more skin ulcers and poorer hygiene compared to non-demented individuals in RC-AL; however, they were restrained less often and had higher family satisfaction with physician communication than those in NHs.
Conclusions:
- Overall quality of palliative care for persons with dementia in long-term care settings does not markedly differ from cognitively intact individuals.
- No large discrepancies in overall palliative care quality were found between RC-AL facilities and NHs for persons with dementia.
- Specific areas requiring improvement in end-of-life care for individuals with dementia were identified.
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