Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
School of Nursing, University College Cork, Cork, Ireland.
Age Ageing. 2022 Mar 1;51(3). doi: 10.1093/ageing/afac066.
Older people with dementia have multiple palliative care needs, with pain, agitation, dyspnoea, aspiration and pressure ulcers being common and persistent in advanced dementia. Anticipating the person's possible symptoms requires knowledge of the whole person, including the type of dementia, which is problematic when the dementia type is often not documented. A palliative care approach to dementia should look at symptoms across the four pillars of palliative care, but in reality, we tend to over-focus on physical and psychological symptoms, while spiritual and emotional needs can be overlooked, especially around the time of diagnosis, where such needs may be significant. Advance care planning (ACP) is a central tenet of good dementia palliative care, as the person may lose their ability to communicate and make complex decisions over time. Despite this, care planning is often approached too late, and with the person's family rather than with the person; much of the literature on ACP in dementia is based on proxy decision-making for people in residential care. Thus, we need a paradigm shift in how we approach dementia, beginning with timely diagnosis that includes the dementia type, and with services able to assess and meet emotional and spiritual needs especially around the time of diagnosis, and with timely ACP as an integral part of our overall approach.
痴呆症老年人有多种姑息治疗需求，疼痛、激越、呼吸困难、误吸和压疮在晚期痴呆症中很常见且持续存在。预测患者可能出现的症状需要了解整个人，包括痴呆症的类型，但当痴呆症类型通常未记录在案时，这就成了一个问题。痴呆症的姑息治疗方法应该着眼于姑息治疗的四个支柱中的所有症状，但实际上，我们往往过于关注身体和心理症状，而忽视了精神和情感需求，尤其是在诊断时，这种需求可能非常重要。预先医疗指示（ACP）是良好痴呆症姑息治疗的核心原则，因为随着时间的推移，患者可能会失去沟通和做出复杂决策的能力。尽管如此，护理计划通常还是太晚了，而且是与患者的家属而不是患者本人一起制定的；痴呆症中关于 ACP 的大部分文献都是基于对居住在养老院的人的代理决策。因此，我们需要改变我们对待痴呆症的方式，从包括痴呆症类型的及时诊断开始，以及有能力评估和满足情感和精神需求的服务，尤其是在诊断时，同时将及时的 ACP 作为我们整体方法的一个组成部分。
