A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia

  title={A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia},
  author={Elizabeth L. Sampson and Craig W. Ritchie and Rosalind Lai and Peter Raven and Martin R. Blanchard},
  journal={International Psychogeriatrics},
  pages={31 - 40}
Background: Patients with dementia often receive poor end-of-life care, with inadequate pain control and without access to the palliative care services that patients with cancer are offered. This has been identified as an area of need in recent U.K. Government reports and by the Alzheimer's Society (U.K.). Our objective was to perform a systematic review of the scientific literature regarding the efficacy of a palliative care model in patients with dementia. Methods: A systematic review was… 

The effectiveness and appropriateness of a palliative approach to care for people with advanced dementia: a systematic review

Textual analysis found that a palliative approach to end of life care in advanced dementia is both appropriate and effective in terms of benefit to patients and their significant others.


Additional investment is needed in education of professionals and the population on the indications and importance of palliative care, as well as in communication strategies as a way to facilitate the effective introduction of such care for people with dementia syndromes.

A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.

The evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, is reviewed.

Interventions for improving palliative care for older people living in nursing care homes.

High quality trials of palliative care service delivery interventions which assess outcomes for residents are needed, particularly outside the USA, and should focus on measuring standard outcomes, assessing cost-effectiveness, and reducing bias.

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

To identify the existing range of models of palliative care that have been evaluated, what is already known and what further information is essential if the most effective and cost-effective models are to be identified and replicated more widely, a review of systematic and narrative reviews is conducted.

Dying with dementia: what we know after more than a decade of research.

With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice, and little evidence supports effectiveness of specific treatments.

Assessment of pain in people living with dementia at the end of life: a systematic review.

There are a range of pain assessment tools appropriate for use in people with dementia but all 15 studies used a formal tool, and a more robust approach is needed to improve the quality of research for measurement and management of pain in this population.

A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia.

There is an urgent need to improve palliative care provision for older people with end-stage dementia and more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end-of-life care.

Integration of a Palliative Approach in the Care of Older Adults with Dementia in Primary Care Settings: A Scoping Review

There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.



Palliative care in advanced dementia: a randomized controlled trial and descriptive analysis.

It was difficult for a palliative care research team to influence the care of advanced dementia patients in the acute hospital setting, and there must be a reexamination of treatment approaches for this severely impaired group of patients.

Can multidisciplinary guidelines improve the palliation of symptoms in the terminal phase of dementia?

This small study suggests that when developed collaboratively, multidisciplinary guidelines can have a positive impact on palliative care for non-oncology patients.

Hospice approach to the treatment of patients with advanced dementia of the Alzheimer type.

Preliminary results indicate that the mortality did not increase significantly during the first year of this program, although the extent of medical care was limited in all patients, and 62% were not treated with antibiotics if they developed symptoms of pneumonia or urinary tract infection.

Palliative Excellence in Alzheimer Care Efforts (PEACE): a program description.

The PEACE program is a disease management model for dementia that incorporates advance planning, patient-centered care, family support, and a palliative care focus from the diagnosis of dementia through its terminal stages, demonstrating an innovative model of providing quality palliatives care for dementia patients and their caregivers.

Palliative and aggressive end-of-life care for patients with dementia.

Use of systemic antibiotics is prevalent in the treatment of patients with end-stage dementia, despite the limited utility and discomfort associated with the use of these agents, and patients with severe dementia and those with milder cognitive impairment received similar treatment.

Differences in supporting families of dementia patients and cancer patients: a palliative perspective

The dominant items for both staff groups were to listen to the family member and to give information, although listening was significantly more often stressed in the palliative group than in the dementia care group.

A Palliative Approach to Existential Issues and Death in End-Stage Dementia Care

Investigation of how municipal staff caring for patients with dementia deal with existential issues, the dying process, and bereavement follow up with next of kin found three patterns of answers emerged: attempting to minimize or ignore the issue, pleading, in relation to the patient, that no one has control over issues concerning life and death, and showing affection for the patient.

Treatment of the dying in the acute care hospital. Advanced dementia and metastatic cancer.

Incurably ill patients often receive nonpalliative interventions at the end of life, and patients with dementia were significantly more likely to receive antibiotics for an identifiable infection than other patients, controlling for neutropenia and invasive tests and treatments.

Effect of Fever-Management Strategy on the Progression of Dementia of the Alzheimer Type

Aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT, which increased over a 3-month period.

Scales for Evaluation of End-of-Life Care in Dementia

Three scales designed to measure outcomes of care of persons suffering from terminal dementia can be used as outcome measures in studies investigating effectiveness of interventions aimed to improve end-of-life care for individuals with dementia.