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

A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. 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.

Frailty assessment and interventions for community-dwelling older adults: a rapid review.

Frailty is a syndrome involving increased vulnerability that usually develops from age-related decline in physiological reserves and function in multiple organ systems, resulting in an impaired ability to respond to acute changes in health conditions. It is imperative that healthcare providers who work with older adults in primary care and community settings understand how to assess frailty and can identify appropriate interventions. This article reports the results of a rapid review that examined how frailty is assessed in community-dwelling older adults and what interventions are used to address frailty in this population.