The extended palliative phase of dementia - An integrative literature review.

This article presents an integrative literature review of the experience of dementia care associated with the extended palliative phase of dementia. The aim was to highlight how dementia is defined in the literature and describe what is known about the symptomatology and management of advanced dementia regarding the needs and preferences of the person with dementia and their family carer/s. There was no consistent definition of advanced dementia. The extended palliative phase was generally synonymous with end-of-life care. Advanced care planning is purported to enable professionals to work together with people with dementia and their families. A lack of understanding of palliative care among frontline practitioners was related to a dearth of educational opportunities in advanced dementia care. There are few robust concepts and theories that embrace living the best life possible during the later stages of dementia. These findings informed our subsequent work around the concept, 'Dementia Palliare'.

The relationship between frailty, functional dependence, and healthcare needs among community-dwelling people with moderate to severe dementia.

This paper examines the healthcare needs of community-dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi-square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home-care program. There was a high number rated as "severe dementia," "fully dependent," "severely or fully dependent in the activities of daily living (ADL)," and "severe frailty." There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well-structured home-care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality-integrated interventions, including the emotional and psychological balance of the caregiver.

Use of power of attorney in Scotland.

BACKGROUND AND AIMS: Power of Attorney as a form of surrogate decision making was introduced within the Adults with Incapacity, Scotland Act (2000) to help individuals who lack mental capacity due to illnesses like dementia. Even after a decade, little was known if it has been useful. We sought to find out how useful the power of attorney document has been so far in supporting people when they lose their capacity and identify any barriers. METHODS AND RESULTS: We did a survey and approached a random sample of 5000 attorneys in Scotland. A total of 1226 attorneys responded; 59% of the respondents had never used their powers but still considered it useful for 'peace of mind'. For the majority, the costs of arranging a power of attorney ranged in between £150 and £300. CONCLUSIONS: The study confirms that power of attorney is useful to safeguard interests of people when they lose capacity. Costs remain a big barrier. Further studies are required to understand the long-term impact of providing financial support to arrange a power of attorney at an early stage on reducing delayed discharges in hospitals.

Drug treatments for Alzheimer's disease.

This article discusses the development and progress of treatment for Alzheimer's disease. Medical treatments have not changed since the late 1990s and have limited effects. They treat the symptoms patients experience but do not reverse the effects or repair neurological damage caused by Alzheimer's disease. Updated NICE guidance and likely future advances in treatment are also

Estimating the prevalence of dementia: cognitive screening in Glasgow nursing homes.

OBJECTIVES: The purpose of this study is to establish existing levels of dementia in nursing homes. DESIGN: The design was a randomised sample of every sixth nursing home resident in Glasgow City. Cognitive testing of 341 residents was carried out using the Standardised Mini Mental State Examination (SMMSE). For clients who had difficulty participating, the Functional Assessment Staging Tool (FAST) was used. Existing dementia diagnoses were compared with the prevalence indicated through cognitive testing. MAIN OUTCOME MEASURES: Standardised Mini Mental State Examination and the FAST were used. SETTING: This study was conducted in the nursing homes in the Glasgow City Council Local Authority, Scotland, UK (N = 49). Forty-eight homes participated in the study and one declined. PARTICIPANTS: The participants were residents of the nursing homes in Glasgow City, including those in existing dementia units (sample = 422 of population 2532); 19 declined and 403 participated. RESULTS: Two hundred thirty-four (58%) residents already had a diagnosis of dementia written in their care plans. One hundred twenty-eight residents (31.8%) without diagnosis of dementia in their care plans scored within the range of possible dementia (less than 24/30 on the SMMSE). A group of 55 (13.6%) residents had no diagnosis of dementia but had some type of cognitive impairment recorded in their notes and scored within the range of possible dementia on the SMMSE. CONCLUSION: Existing levels of dementia diagnosis are 58%. This study finds an additional 31.8% of residents without a diagnosis of dementia who score within the range of possible dementia, giving a ceiling of 89.8%. It appears that underdiagnosis of dementia exists within this 31.8% group.

Care needs of elderly people with schizophrenia. Assessment of an epidemiologically defined cohort in Scotland.

BACKGROUND: Little is known of the needs of elderly patients with psychotic illnesses. AIMS: To measure the care needs of an epidemiologically based group of patients over the age of 65 years suffering from psychotic illness, using a standardised assessment. METHOD: All patients aged 65 years and over with a diagnosis of schizophrenia and related disorders from a defined catchment area were identified. Their health and social care needs were investigated using the Cardinal Needs Schedule. RESULTS: The 1-year prevalence of schizophrenia and related disorders was 4.44 per 1000 of the population at risk. There were high levels of unmet need for many patients, including those in National Health Service (NHS) continuing-care beds. CONCLUSIONS: Many needs were identified, all of which could be addressed using the existing skills of local health and social care professionals. The investigation raises serious concerns about standards of hospital and community care for elderly patients with schizophrenia. The findings may be unique, reflecting long-standing problems within a particularly hard-pressed part of the NHS. However, it is not known whether a similar situation exists in other parts of the UK.

Behaviour problems and assessment in dementia.

People with dementia develop behaviour problems, the causes of which are often complex. Such behaviour often challenges the ability to provide care. Patient dignity must always be considered when attempting to reduce antisocial behaviour. Medication may be necessary but should not be seen as a first resort. Cognitive testing, rating scales, physical examination, biochemical tests and brain scans are used to confirm a diagnosis of dementia.

Common forms of dementia.

Dementia occurs in various forms and may be associated with other conditions (secondary dementias). Each type has a different impact on the brain, leading to a variety of cognitive losses and behaviour problems. Appropriate identification is vital so that the most suitable treatment can be instigated.

Dementia: Alzheimer's disease.

Dementia is a common condition that will increase as the average age of the population increases. It is a syndrome with major health and social implications. There are many different types of dementia and the effects of the illness relate to which parts of the brain are affected. This article looks at the types of brain damage that occur, and focuses on Alzheimer's disease.

Person-centred care in dementia.

People with dementia, particularly in its early stages, are aware of their problems, therefore it is vital that they are told of their diagnosis so they can make decisions about their future. The development of new drugs has led to major changes in the management of dementia, but 'postcode prescribing' means that all drugs are not widely available. Various means of support are available for patients and their carers but at all times healthcare professionals must ensure that the person is at the centre of a patient's care.