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

Shirin Vellani,Christine Degan,Katherine S Mcgilton,Martine Puts,Andrea Iaboni

doi:10.1017/s0714980821000349

Abstract

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.

Highlights

Dementia is a terminal illness; the disease trajectory is highly unpredictable, making prognostication difficult (Smith & Ferguson, 2017)
We aim to examine the literature guided by the following questions: 1. What are the nurses’ and physicians’ perspectives and experiences regarding the integration of a palliative approach in the care of older adults with dementia in primary care settings?
Of the 17 studies, 8 addressed the perspectives of physicians and/or nurses, whereas, 9 studies reported on the impact of a palliative approach in the care of older adults with dementia in primary care settings (Carduff et al, 2016; Clevenger, Cellar, Kovaleva, Medders, & Hepburn, 2018; Daaleman et al, 2019; Holley, Gorawara-Bhat, Dale, Hemmerich, & Cox-Hayley, 2009; Hum et al, 2018; London, McSkimming, Drew, Quinn, & Carney, 2005; Nakanishi, Hirooka, Morimoto, & Nishida, 2017; Sternberg et al, 2019; Treloar, Crugel, & Adamis, 2009)

Summary

Introduction

Dementia is a terminal illness; the disease trajectory is highly unpredictable, making prognostication difficult (Smith & Ferguson, 2017). Dementia is typically complicated by the presence of multiple chronic diseases, increasing the risk for frequent hospitalizations and emergency department visits (Mondor et al, 2017). As cognitive abilities and decision-making capacity worsen, caregivers are expected to make care decisions on behalf of the persons living with dementia, which may exert increased caregiver burden (Gofton, Jog, & Schulz, 2009) and care that may be discordant with wishes of the care recipients. In the last year of their life, people with advanced dementia may receive burdensome medical interventions such as enteral nutrition, and suboptimal management of pain (Cintra, de Rezende, de Moraes, Cunha, & da Gama Torres, 2014)

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