Palliative care of persons with dementia and delirium

Abstract

The number of people with dementia and delirium not induced by alcohol and other psychoactive substances has significantly increased during the last decades and will rise further in the future, particularly in the oldest old. In the vast majority of cases dementia is characterized by aprogressive course with shortened life expectancy and a lack of curative treatment options. Delirium will remit in many cases; however, in asubstantial proportion of patients the further course is unfavorable. Life expectancy is greatly reduced in these patients, mostly in association with advanced dementia and age-related multimorbidity. Intensified inclusion of palliative medical care aspects in the planning of treatment is indicated in the context of advanced and incurable conditions associated with a presumably clearly reduced life expectancy. The aim is to achieve the best possible relief of distressing somatic and psychiatric symptoms for the sake of the patients and their families. The competencies of psychiatry and palliative care can complement each other in this respect. In addition, there is aneed for healthcare policy measures beyond the associated interdisciplinary opportunities and challenges in order to establish the necessary healthcare structures.