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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,...
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Palliative care interventions in advanced dementia.

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Palliative care interventions for advanced dementia show limited evidence, with advance care planning likely improving documentation and discussions of care goals. However, overall evidence certainty remains low.

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Area of Science:

  • Gerontology and Geriatric Medicine
  • Neuroscience and Neurology
  • Palliative Care and End-of-Life Studies

Background:

  • Advanced dementia is a progressive, fatal neurodegenerative disease characterized by severe cognitive impairment and functional dependence.
  • Palliative care, traditionally focused on cancer, is increasingly recognized as essential for all life-limiting illnesses, including dementia.
  • This review updates a previous 2016 assessment of palliative care interventions in advanced dementia.

Purpose of the Study:

  • To evaluate the effectiveness of palliative care interventions for individuals with advanced dementia.
  • To synthesize evidence from randomized and non-randomized controlled trials on palliative care in advanced dementia.

Main Methods:

  • Comprehensive literature search of ALOIS, MEDLINE, Embase, and other databases up to October 2020.
  • Inclusion of randomized controlled trials (RCTs), cluster-RCTs, and controlled before-and-after studies.
  • Independent data extraction and risk of bias assessment by multiple reviewers, with meta-analysis where appropriate.

Main Results:

  • Organization and delivery of care interventions showed very low certainty evidence for improving comfort in dying and palliative care plan likelihood.
  • Advance care planning interventions likely increase advance directive documentation and discussions about goals of care (moderate certainty evidence).
  • Interventions had little to no effect on non-palliative intervention use, advance directive documentation, or advance care planning discussions in some comparisons.

Conclusions:

  • Evidence for palliative care interventions in advanced dementia is limited in quantity and certainty.
  • Advance care planning interventions show promise for improving documentation and goal-of-care discussions, despite low to moderate certainty evidence.
  • Further research is needed to clarify the benefits and impact of palliative care interventions due to imprecision and risk of bias in current studies.