Palliative care in dementia

Objectives: To analyze the current literature on the various aspects of palliative care in advanced dementia (AD). Material and methods: A narrative review focused on the literature available regarding the final stages of dementia: prognosis, decision-making, assessment of patient needs, support/alleviation of symptoms and the integration of palliative care into the comprehensive care of AD. Results: AD is a terminal disease associated with extensive suffering and having to make difficult decisions in its most severe stages. Estimating prognosis is difficult, which may explain why most patients are not included in palliative care programs. The decision-making process is characterized by uncertainty due to the lack of scientific evidence backing the efficacy of treatments and the need to reconcile conflictive points of view, as well as due to the difficulty of understanding patient wishes. Caring for these patients is difficult; for them, non-verbal communication is essential and careful attention to the presence of symptoms is required. It is also necessary to take into consideration the suffering of caregivers. The few studies that have developed specific tools for guiding the final phase of life in AD and the specific measurements of outcomes have demonstrated what can be achieved and the significant work ahead. Conclusions: Further research on end-of-life care for persons with dementia is needed in order to develop interventions that address the particular challenges of dying with this disease and to be able to improve the end-of-life care provided to these patients in the environments where the majority of them live and die. (c) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.