Eisenmann Yvonne, Golla Heidrun, Schmidt Holger, Voltz Raymond, Perrar Klaus Maria
Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Front Psychiatry. 2020 Jul 21;11:699. doi: 10.3389/fpsyt.2020.00699. eCollection 2020.
Dementia syndrome is common and expected to increase significantly among older people and characterized by the loss of cognitive, psychological and physical functions. Palliative care is applicable for people with dementia, however they are less likely to have access to palliative care. This narrative review summarizes specifics of palliative care in advanced dementia. Most people with advanced dementia live and die in institutional care and they suffer a range of burdensome symptoms and complications. Shortly before dying people with advanced dementia suffer symptoms as pain, eating problems, breathlessness, neuropsychiatric symptoms, and complications as respiratory or urinary infections and frequently experience burdensome transitions. Pharmacological and nonpharmacological interventions may reduce symptom burden. Sensitive observation and appropriate assessment tools enable health professionals to assess symptoms and needs and to evaluate interventions. Due to lack of decisional capacity, proxy decision making is often necessary. Advanced care planning is an opportunity establishing values and preferences and is associated with comfort and decrease of burdensome interventions. Family carers are important for people with advanced dementia they also experience distress and are in need for support. Recommendations refer to early integration of palliative care, recognizing signs of approaching death, symptom assessment and management, advanced care planning, person-centered care, continuity of care, and collaboration of health care providers.
痴呆综合征很常见，预计在老年人中会显著增加，其特征是认知、心理和身体功能丧失。姑息治疗适用于痴呆患者，但他们获得姑息治疗的可能性较小。本叙述性综述总结了晚期痴呆姑息治疗的具体情况。大多数晚期痴呆患者在机构护理中生活和死亡，他们遭受一系列繁重的症状和并发症。在临终前不久，晚期痴呆患者会出现疼痛、进食问题、呼吸困难、神经精神症状等症状，以及呼吸或泌尿感染等并发症，并经常经历繁重的转变。药物和非药物干预可能会减轻症状负担。敏锐的观察和适当的评估工具使卫生专业人员能够评估症状和需求，并评估干预措施。由于缺乏决策能力，往往需要代理决策。预先护理计划是一个确立价值观和偏好的机会，与舒适度提高和减少繁重干预措施相关。家庭照顾者对晚期痴呆患者很重要，他们也会感到痛苦，需要支持。建议包括姑息治疗的早期整合、识别临近死亡的迹象、症状评估和管理、预先护理计划、以人为本的护理、护理的连续性以及医疗保健提供者之间的合作。
