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de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia: A Scoping Review. J Pain Symptom Manage 2024:S0885-3924(24)00798-X. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science REVIEW METHODS: We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
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Affiliation(s)
- Karen de Sola-Smith
- VA Quality Scholar Nurse Practitioner Fellow, San Francisco Veterans Affairs Medical Center; Department of Physiological Nursing, University of California San Francisco, CA, United States.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Department of Public Health and Primary Care, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Department of Public Health and Primary Care, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI), Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; Department of Physiological Nursing, University of California San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, United States
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Factors associated with the intention to engage in care planning among persons with mild cognitive impairment and dementia. Geriatr Nurs 2023; 50:143-151. [PMID: 36780712 DOI: 10.1016/j.gerinurse.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/13/2023]
Abstract
This study examined factors associated with the intention to engage in advance care planning among persons with cognitive impairment. This cross-sectional study recruited 116 persons with cognitive impairment by convenience sampling from two teaching hospitals in Northern Taiwan from November 1, 2018, to December 31, 2020. Fewer than 50% of the participants intended to engage in advance care planning, and less than 10% signed the living will for hospice and palliative care. Multivariate linear regression determined factors influencing advance care planning intention included education level, a proxy signed do-not-resuscitate document, belief that family members would provide a signed do-not-resuscitate at their end-of-life, and necessity of explaining future care in advance. It is recommended to popularize advance care planning education and ensure the rights of persons with cognitive impairment to enable them to fully participate in their own care plans through family-centered advance care planning.
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Stelma-Roorda HN, Eichelsheim VI. Decision-making by and for adults with impaired capacity: The potential of the Dutch levenstestament. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 86:101844. [PMID: 36442390 DOI: 10.1016/j.ijlp.2022.101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Anticipatory decision-making instruments - continuing powers of attorney and advance directives - are increasingly seen as a promising way forward to enhance the autonomy of adults with impaired capacity by making the adult's voice an influential component of future decisions. However, little is known about the experiences with these instruments in practice. This article presents the findings of an interview study looking at the expectations and experiences of both adults and attorneys with a Dutch anticipatory decision-making instrument, the so-called levenstestament. In order to realise its full potential, anticipatory decision-making instruments, such as the levenstestament, should be embedded in robust, timely and ongoing conversations between adults and attorneys about the adult's (changing) wishes and preferences and the role of the attorney.
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Affiliation(s)
- H N Stelma-Roorda
- Faculty of Law, Vrije Universiteit Amsterdam, De Boelelaan 1105, HV 1081, Amsterdam.
| | - V I Eichelsheim
- Netherlands Institute for the Study of Crime and Law Enforcement, PO Box 71304, BH 1008, Amsterdam.
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Visser M, Smaling HJA, Parker D, van der Steen JT. How Do We Talk With People Living With Dementia About Future Care: A Scoping Review. Front Psychol 2022; 13:849100. [PMID: 35496203 PMCID: PMC9039178 DOI: 10.3389/fpsyg.2022.849100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning (ACP) for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In November 2020, seven databases were searched to select papers for inclusion (Proquest, Medline, Embase, Scopus, Psycinfo, Amed, and Cinahl). This search was updated in December 2021. The search strategy consisted of three tiers (related terms to "dementia," "communication" and "ACP"), intersected by using the Boolean term "AND," and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics (i.e., importance of having ACP conversations, knowledge gap, inclusion of people with dementia in ACP conversations, policy vs. practice, adapting to cognitive changes, adapting to psychosocial changes, and adapting to emotional changes) emerged clustered around two themes (i.e., communicating with people with dementia in ACP, and changes in communication due to dementia). This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences.
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Affiliation(s)
- Mandy Visser
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Deborah Parker
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
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Chu CK, Saunders A, Parish S, Hetherton N, Cross S, Attoe C. End of Life Care and Advance Care Planning for People with Dementia: A Pilot Simulation Course for Healthcare Professionals. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A Perspective Roadmap for IoMT-Based Early Detection and Care of the Neural Disorder, Dementia. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6712424. [PMID: 34880977 PMCID: PMC8648455 DOI: 10.1155/2021/6712424] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/12/2021] [Indexed: 12/05/2022]
Abstract
The Internet of Medical Things (IoMT) has emerged as one of the most important key applications of IoT. IoMT makes the diagnosis and care more convenient and reliable with proven results. The paper presents the technology, open issues, and challenges of IoMT-based systems. It explores the various types of sensors and smart equipment based on IoMT and used for diagnosis and patient care. A comprehensive survey of early detection and postdetection care of the neural disorder dementia is conducted. The paper also presents a postdiagnosis dementia care model named “Demencare.” This model incorporates eight sensors capable of tracking the daily routine of dementia patient. The patients can be monitored locally by an edge computing device kept at their premises. The medical experts may also monitor the patients' status for any deviation from normal behavior. IoMT enables better postdiagnosis care for neural disorders, like dementia and Alzheimer's. The patient's behavior and vital parameters are always available despite the remote location of the patients. The data of the patients may be classified, and new insights may be obtained to tackle patients in a better manner.
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Sussman T, Pimienta R, Hayward A. Engaging persons with dementia in advance care planning: Challenges and opportunities. DEMENTIA 2020; 20:1859-1874. [PMID: 33290098 DOI: 10.1177/1471301220973059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study reports findings from a series of focus groups with persons with dementia and family caregivers intended to explore: (1) perceptions of and experiences with advance care planning (ACP); (2) concerns related to future care including, but not limited to, end-of-life care; and (3) practices that may support positive engagement with ACP. A total of 18 participants including 10 persons with dementia and eight family caregivers participated in five focus groups held in two urban cities in Canada. All focus group deliberations were audio recorded, transcribed verbatim, and analyzed in five stages using a semantic thematic approach. All participants expressed some form of engagement in ACP, but understandings were limited and divergence was expressed regarding the timing of more expansive conversations about future care. Although some persons with dementia were ready to engage in future care discussions, most preferred focusing on the present and suggested their families did not require direction. This placed families in the complex dilemma of protecting their loved ones while compromising their own needs for dialogue. Although individually focused models of ACP engagement hold promise for those persons with dementia ready to engage in future planning, our findings suggest that early engagement of families in the reflective process may go a long way in supporting ACP activation. Our findings further suggest that persons with dementia who do not have close family/friends may require extensive ACP encouragement and support from service providers.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - Rebecca Pimienta
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - April Hayward
- Special Care Counselling, 91424Vanier College, Montreal, Quebec, Canada
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Phenwan T, Sixsmith J, McSwiggan L, Buchanan D. A narrative review of facilitating and inhibiting factors in advance care planning initiation in people with dementia. Eur Geriatr Med 2020; 11:353-368. [PMID: 32297272 PMCID: PMC7280342 DOI: 10.1007/s41999-020-00314-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
Aim To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD). Findings All articles included for the analysis came from countries that have supportive regulations and guidelines for ACP.
ACP initiation amongst PwD is a complex decision that involves several stakeholders who have different knowledge and attitudes of ACP. Message More research is required on ACP education, initiation timing given the disease trajectory, and changing family dynamics overtime. Electronic supplementary material The online version of this article (10.1007/s41999-020-00314-1) contains supplementary material, which is available to authorized users. Purpose of the review To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD). Methods A narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussion. Results Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP. Conclusion This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics. Electronic supplementary material The online version of this article (10.1007/s41999-020-00314-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tharin Phenwan
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
| | - Judith Sixsmith
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Linda McSwiggan
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Deans Buchanan
- NHS Tayside and Dundee Health and Social Care Partnership, Dundee, UK.,School of Medicine, University of Dundee, Dundee, UK.,Tayside Palliative and End of Life Care Managed Care Network, Tayside, UK
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Harrison Dening K, Sampson EL, De Vries K. Advance care planning in dementia: recommendations for healthcare professionals. Palliat Care 2019; 12:1178224219826579. [PMID: 30833812 PMCID: PMC6393818 DOI: 10.1177/1178224219826579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
The process of advance care planning in dementia is far from straightforward; as dementia progresses, the ability to consider future thoughts and actions becomes compromised, thus affecting decision-making abilities. Family carers find themselves increasingly in a position where they need to inform, or directly make, decisions on behalf of the person with dementia. This article discusses the context and importance of a palliative care approach and recommends rationales and strategies for healthcare professionals to support families affected by dementia to better plan for their future care.
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Affiliation(s)
- Karen Harrison Dening
- Research & Publications, Dementia UK, London, UK; School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
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