Gateshead Health NHS Foundation Trust, Gateshead, UK.
St Oswald's Hospice, Gosforth, UK.
Evid Based Ment Health. 2018 Aug;21(3):107-111. doi: 10.1136/eb-2018-102889. Epub 2018 May 18.
Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild-moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals' prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection. To navigate complexity at the end of life, open communication that involves patients and families in decisions, and is responsive to their needs is vital and can vastly improve subjective experiences. Complex ethical dilemmas may pervade both the illness of dementia and provision of palliative care; we consider how ethical issues (eg, providing care under restraint) influence complex decisions relating to resuscitation, artificial nutrition and treatment refusal in order to optimise quality of life.
痴呆是一种慢性进行性疾病，现在得到了更广泛的认识和治疗。当痴呆患者进入疾病终末期时，可能需要姑息治疗，或者他们可能患有轻度至中度认知症状，同时患有生命有限的疾病。各种表现形式需要对护理计划进行高度个体化的方法，应鼓励患者设定自己的目标，并在可能的情况下为高级护理计划做出贡献。通过详细了解个人的先前意愿、跨学科沟通以及识别可能由新症状引起的表现变化（例如疼痛、营养不足和感染），可以极大地帮助在生命末期评估和管理痛苦症状。为了在生命末期应对复杂性，涉及患者和家属的开放沟通，以及对他们的需求做出响应是至关重要的，这可以极大地改善主观体验。复杂的伦理困境可能贯穿于痴呆症和姑息治疗；我们考虑了伦理问题（例如，在限制下提供护理）如何影响与复苏、人工营养和治疗拒绝相关的复杂决策，以优化生活质量。
