Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries.

Shelley A Sternberg,Shiri Shinan-Altman,David J Casarett,Jenny T Van Der Steen,Ladislav Volicer

doi:10.3390/geriatrics6020044

Abstract

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), The Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and The Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in The Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in The Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in The Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

Highlights

Dementia affects the individuals living with it, their families, and the health and social care systems that provide and pay for care [1]
Quality of life in advanced dementia is affected by location of care, which should fit the specific needs of persons with advanced dementia [11,12,13], and provision of palliative care, the evidence base is smaller than for persons with, for example, cancer [14,15]
We provide a detailed discussion of a case example of Mrs S, a woman with advanced dementia and a life expectancy of less than 6 months [20], in order to demonstrate and discuss the different care that she would likely receive in each of the United States (US), The Netherlands and Israel

Summary

Introduction

Dementia affects the individuals living with it, their families, and the health and social care systems that provide and pay for care [1]. Dementia is associated with a shortened life expectancy [2,3], but often, it is not perceived to be a terminal illness This limits the adoption of a palliative approach to care [4]. We review care that older people with advanced dementia would most likely receive in the United States of America (US), The Netherlands, and Israel with an emphasis on place of residence and access to palliative care, including hospice services, and treatment. These three countries have been highlighted because of differences in the provision of long-term care. Long-term care data of the Organization for Economic Co-operation and Development (OECD) [6] showed that 10% of the population aged 65 years and over in the US received long-term care compared to 13% in The

Methods

Discussion

Conclusion