University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK.
ENRICH Scotland, Neuroprogressive & Dementia Network Level 5, Corridor M Ninewells Hospital, Dundee, UK.
Curr Opin Support Palliat Care. 2024 Dec 1;18(4):219-223. doi: 10.1097/SPC.0000000000000733. Epub 2024 Oct 30.
This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings.
Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support.
Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.
本文旨在综合当前有关生命终末期晚期痴呆症患者症状管理的研究。重点介绍姑息治疗和痴呆症护理专家所面临的独特挑战，深入探讨在各种护理环境中支持晚期痴呆症患者所需的临床决策。
最近的研究表明，晚期痴呆症患者通常存在未满足的姑息治疗需求，特别是在症状管理方面。疼痛、呼吸困难和心理困扰经常得不到妥善处理，导致护理质量不佳。此外，痴呆症的不可预测轨迹使得终末期需求的识别变得复杂，从而导致护理碎片化。无论是专业护理人员还是家庭护理人员，在管理复杂症状时都面临困难，而家庭护理人员在居家环境中则面临着在缺乏足够支持的情况下提供护理的额外负担。
由于缺乏针对性干预措施、症状管理不善以及护理系统不连贯，目前对晚期痴呆症患者的姑息治疗还远远不够。加强对护理人员的培训，促进跨学科合作，并关注家庭和机构环境中综合护理方法，对于提高晚期痴呆症患者的生活质量和症状控制至关重要。
