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生命终末期的痴呆症护理:当前方法。

Dementia Care at End of Life: Current Approaches.

机构信息

Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA.

Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

出版信息

Curr Psychiatry Rep. 2018 Jun 23;20(7):50. doi: 10.1007/s11920-018-0915-x.

DOI:10.1007/s11920-018-0915-x
PMID:29936639
Abstract

PURPOSE OF REVIEW

Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia.

RECENT FINDINGS

Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia. Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.

摘要

目的综述

痴呆是一种进行性且危及生命的疾病,可以分为早、中、晚期三个阶段。本文综述了晚期痴呆的现有文献。

最近的发现

不同类型的痴呆患者的存活时间可能不同。然而,整体轨迹是逐渐下降,直到死亡。理想情况下,随着痴呆患者接近生命的尽头,护理应该侧重于舒适、尊严和生活质量。然而,在痴呆症的最后阶段,存在障碍会妨碍最佳的临终关怀。为痴呆患者及其护理人员提供更好和更早的高级护理计划,可以帮助确定护理目标,并为终末期痴呆症的不可避免的并发症做好准备。这可以使他们及时获得姑息治疗和临终关怀,从而最终改善痴呆症的临终关怀。

相似文献

1
Dementia Care at End of Life: Current Approaches.生命终末期的痴呆症护理:当前方法。
Curr Psychiatry Rep. 2018 Jun 23;20(7):50. doi: 10.1007/s11920-018-0915-x.
2
Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial.便利式家庭病例讨论会对晚期痴呆症的影响:一项整群随机临床试验。
PLoS One. 2017 Aug 7;12(8):e0181020. doi: 10.1371/journal.pone.0181020. eCollection 2017.
3
[Palliative care for persons with dementia].[痴呆症患者的姑息治疗]
Hu Li Za Zhi. 2011 Feb;58(1):91-6.
4
A co-design process developing heuristics for practitioners providing end of life care for people with dementia.一个共同设计过程,旨在为为痴呆症患者提供临终关怀的从业者制定启发式方法。
BMC Palliat Care. 2016 Aug 2;15:68. doi: 10.1186/s12904-016-0146-z.
5
IssuEs in Palliative care for people in advanced and terminal stages of Young-onset and Late-Onset dementia in GErmany (EPYLOGE): the study protocol.德国早发性和晚发性痴呆晚期和终末期患者姑息治疗中的问题(EPYLOGE):研究方案。
BMC Psychiatry. 2018 Aug 31;18(1):271. doi: 10.1186/s12888-018-1846-0.
6
Identifying palliative care needs in people with dementia.识别痴呆症患者的姑息治疗需求。
Curr Opin Support Palliat Care. 2017 Dec;11(4):328-333. doi: 10.1097/SPC.0000000000000295.
7
Goals of care in advanced dementia: quality of life, dignity and comfort.晚期痴呆症的护理目标:生活质量、尊严与舒适。
J Nutr Health Aging. 2007 Nov-Dec;11(6):481.
8
Meaningful connections in dementia end of life care in long term care homes.长期护理院痴呆症临终关怀中的有意义联系。
BMC Psychiatry. 2018 Sep 24;18(1):307. doi: 10.1186/s12888-018-1882-9.
9
Palliative Care for Dementia.痴呆症的姑息治疗
Psychiatr Clin North Am. 2018 Mar;41(1):141-151. doi: 10.1016/j.psc.2017.10.011. Epub 2017 Nov 27.
10
Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development.晚期痴呆症患者的姑息治疗:一项为服务发展提供信息的混合方法定性研究。
BMC Palliat Care. 2017 Apr 28;16(1):28. doi: 10.1186/s12904-017-0201-4.

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NHANES 2011-2014: Association Between Conicity Index and Cognitive Performance in Older Adults.美国国家健康与营养检查调查(2011 - 2014年):老年人圆锥指数与认知表现之间的关联
Alpha Psychiatry. 2025 Aug 25;26(4):46031. doi: 10.31083/AP46031. eCollection 2025 Aug.
2
Views of Family Caregivers on Advance Care Planning in Advanced Dementia Care in Hong Kong: A Qualitative Thematic Content Analysis Study.香港晚期痴呆症护理中家庭照顾者对预先护理计划的看法:一项定性主题内容分析研究
Health Sci Rep. 2025 Jul 9;8(7):e70983. doi: 10.1002/hsr2.70983. eCollection 2025 Jul.
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Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings.

本文引用的文献

1
The Effectiveness of Advance Care Planning in Improving End-of-Life Outcomes for People With Dementia and Their Carers: A Systematic Review and Critical Discussion.《预先医疗指示对改善痴呆患者及其照护者临终结局的有效性:系统评价和批判性讨论》。
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Complex Clinical Intersection: Palliative Care in Patients with Dementia.复杂临床交叉点:痴呆症患者的姑息治疗。
Am J Geriatr Psychiatry. 2018 Feb;26(2):224-234. doi: 10.1016/j.jagp.2017.06.015. Epub 2017 Jun 29.
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Societal and Family Lifetime Cost of Dementia: Implications for Policy.
医护人员的认知偏差和道德特征及其在急症护理环境中对晚期痴呆患者的治疗方法。
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Junior medical doctors' decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study.初级医生在使用预先指示指导痴呆患者治疗时的决策:一项横断面病例研究。
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Euthanasia in Dementia: A Narrative Review of Legislation and Practices in the Netherlands and Belgium.痴呆症中的安乐死:荷兰和比利时立法与实践的叙述性综述
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Effect of providing purple sweet potato water extract on tumor necrosis factor-α levels, protein 53 expression, glial fibrillary acidic protein expression, brain-derived neurotrophic factor levels, and spatial working memory in rats with d-galactose induction.给予紫薯水提取物对D-半乳糖诱导的大鼠肿瘤坏死因子-α水平、蛋白53表达、胶质纤维酸性蛋白表达、脑源性神经营养因子水平及空间工作记忆的影响。
Dement Neuropsychol. 2022 Apr-Jun;16(2):228-236. doi: 10.1590/1980-5764-DN-2021-0090. Epub 2022 Jun 6.
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Accuracy of two prognostic indexes to predict mortality in older adults with advanced dementia.两种预后指标预测晚期痴呆老年人死亡率的准确性。
Dement Neuropsychol. 2022 Jan-Mar;16(1):52-60. doi: 10.1590/1980-5764-DN-2021-0028.
8
Towards personalized dementia care through meaningful activities supported by technology: A multisite qualitative study with care professionals.通过技术支持的有意义活动实现个性化痴呆症护理:一项多地点的护理专业人员定性研究。
BMC Geriatr. 2021 Aug 21;21(1):468. doi: 10.1186/s12877-021-02408-2.
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"It is always me against the Norwegian system." barriers and facilitators in accessing and using dementia care by minority ethnic groups in Norway: a qualitative study.“我总是与挪威的制度作斗争。”挪威少数民族获取和使用痴呆症护理的障碍和促进因素:一项定性研究。
BMC Health Serv Res. 2020 Oct 15;20(1):954. doi: 10.1186/s12913-020-05801-6.
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Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China.中国认知障碍患者的护理和管理专家共识。
Neurosci Bull. 2020 Mar;36(3):307-320. doi: 10.1007/s12264-019-00444-y. Epub 2019 Dec 2.
痴呆症的社会和家庭终生成本:对政策的影响。
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Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence.影响养老院痴呆患者抗精神病药物处方决策的因素:系统评价和定性证据综合。
J Am Med Dir Assoc. 2017 Oct 1;18(10):897.e1-897.e12. doi: 10.1016/j.jamda.2017.06.032. Epub 2017 Aug 12.
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Level of Care Preferences Among Nursing Home Residents With Advanced Dementia.养老院中患有晚期痴呆症的居民的护理水平偏好。
J Pain Symptom Manage. 2017 Sep;54(3):340-345. doi: 10.1016/j.jpainsymman.2017.04.020. Epub 2017 Aug 8.
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Barriers to palliative care for advanced dementia: a scoping review.晚期痴呆症姑息治疗的障碍:一项范围综述
Ann Palliat Med. 2017 Oct;6(4):365-379. doi: 10.21037/apm.2017.06.13.
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Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia.西酞普兰与非典型抗精神病药治疗阿尔茨海默病痴呆老年住院患者激越的疗效和安全性比较。
J Am Med Dir Assoc. 2017 Sep 1;18(9):799-802. doi: 10.1016/j.jamda.2017.06.010. Epub 2017 Jul 21.
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The Diagnosis and Treatment of Behavioral Disorders in Dementia.痴呆行为障碍的诊断与治疗。
Dtsch Arztebl Int. 2017 Jun 30;114(26):447-454. doi: 10.3238/arztebl.2017.0447.
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Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care.大约每三个美国成年人中就有一个完成了任何类型的临终关怀预先指示。
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End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice.痴呆症患者的临终关怀:卫生专业人员、社会护理服务经理和一线工作人员对良好实践关键要求的看法。
PLoS One. 2017 Jun 16;12(6):e0179355. doi: 10.1371/journal.pone.0179355. eCollection 2017.