Demencia avanzada y cuidados paliativos: características sociodemográficas y clínicas

Abstract

IntroductionThe need to incorporate palliative care treatment of advanced dementia patients into health care is now well known and accepted. The aim of this study is to describe the sociodemographic and clinical characteristics of patient with advanced dementia who needed palliative treatment when they were admitted to a Psychogeriatric Unit. The study also assessed the caregiver's burden and emotional discomfort. Material and methodsSociodemographic and clinical data was collected from patients admitted to the Psychogeriatric Unit. The patients were diagnosed with advanced dementia according to Hospice Enrolment Criteria for end-stage dementia patients. The questionnaires Zarit Burden Interview (ZR), and the General Health Questionnaire (GHQ-28) were used to assess the caregivers. ResultsA total of 27 patients were assessed. The most prevalent type of dementia was Alzheimer's disease (51.9%). As regards the functional status of the patients, a great number of them were unable to sit independently (59.3%); others were unable to walk (37%), while others had loss of all intelligible vocabulary (25.9%). The comorbidities associated with advanced dementia were: eating problems (81.5%), ulcers (33.3%), pyelonephritis (29.6%), febrile episodes (22.2%), pneumonia (18.5%), septicaemia (14.8%) and an albumin less than 2.5g/dl (11.1%). The most frequent length of care with high dependence from caregivers was 6-20 months (25.9%) and 2-3 years (33.3%). Caregivers were women (68.4%), and the most frequent family relationship between patient and caregiver was son/daughter (74.1%). The mean score in caregiver's emotional distress was clinically significant (GHQ-28: 8.58, SD: 5.73), and there were higher scores for caregiver's burden (ZR: 45.64, SD: 10.09). ConclusionsThe identification and inclusion of patients with advanced dementia into the palliative care program could provide control of symptoms at the end of life of dementia patients. Moreover, it could also offer emotional support to the family within the health care system.