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Related Experiment Videos

Palliative care interventions in advanced dementia.

Edel Murphy1, Katherine Froggatt2, Sheelah Connolly3

  • 1HRB Primary Care Clinical Trials Network Ireland, NUI Galway, Galway, Ireland.

The Cochrane Database of Systematic Reviews
|December 3, 2016
PubMed
Summary

Palliative care interventions for advanced dementia show insufficient evidence due to limited, heterogeneous studies. More research is needed, with six ongoing studies indicating growing interest in this vital area.

Related Experiment Videos

Area of Science:

  • Neuroscience
  • Gerontology
  • Palliative Care

Background:

  • Advanced dementia is a progressive neurodegenerative disease characterized by severe cognitive impairment and functional dependence.
  • Current care for advanced dementia often lacks a universally applied palliative approach.
  • There's a growing global call to extend palliative care services to all individuals with life-limiting illnesses, including dementia.

Purpose of the Study:

  • To evaluate the effectiveness of palliative care interventions for individuals with advanced dementia.
  • To document the various outcome measures utilized in studies of palliative care for advanced dementia.

Main Methods:

  • Searched multiple databases (e.g., MEDLINE, Embase, PsycINFO) and trial registries for randomized controlled trials (RCTs), non-randomized controlled trials (nRCTs), controlled before-and-after studies (CBA), and interrupted time series studies.
  • Included studies evaluating palliative care interventions for adults with any type of dementia staged as advanced.
  • Two independent reviewers assessed study eligibility, extracted data, and evaluated methodological quality using Cochrane methods.

Main Results:

  • Only two studies met the inclusion criteria, with significant heterogeneity in interventions and settings, precluding meta-analysis.
  • One RCT found palliative care plans were more likely to be developed and available upon discharge for hospitalized patients, but no effect on mortality was observed.
  • A cluster RCT subset indicated reduced decisional conflict and increased discussion of feeding options among surrogate decision-makers, though with considerable uncertainty due to imprecision.

Conclusions:

  • There is insufficient evidence to definitively assess the impact of palliative care interventions in advanced dementia.
  • The two included studies were at high risk of bias, and the overall certainty of evidence was very low.
  • Six ongoing studies suggest increasing research interest, highlighting the need for further investigation in this field.