[Palliative care for patients with advanced dementia: Evidence-based practice replaced by values-based practice].
For the treatment of patients with advanced dementia, we could not find any evidence based guidelines to help in decision making. Individual values and expected quality of life must be the leading goals of any intervention. Symptom control and relieving suffering are core values of palliative care, but the recognition of discomfort needs qualified assessment skills. Pain assessment with common tools like the VAS fails in patients with cognitive impairment and inability to communicate; instruments like Doloplus and ECPA can be helpful to assess behavioral changes as expression of pain. The treatment of acute and chronic pain in advanced dementia is still not sufficient and needs improvement. Oral feeding in advanced dementia becomes more and more difficult. No randomized controlled study has found evidence that tube feeding will reduce the risk of aspiration or prolong life expectancy. Eating may be the only meaningful activity that remains for the patient; artificial feeding cannot serve the same function. All final complications, like pneumonia, call for a decision making process. Those who care for and care about these patients must make decisions. The feelings of the family have to be considered, but the probable will of the patient, his dignity and quality of life must not be overridden.
Pflegezentrum Spital Limmattal, Urdorferstr. 100, 8952 Schlieren, Switzerland. roland.kunz@spital-limmattal.ch
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D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000451:nursing* / Q000523:psychology; D019091:Critical Pathways; D004750:Enteral Nutrition / Q000523:psychology; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D008020:Life Support Care / Q000523:psychology; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D017410:Practice Guidelines as Topic; D011788:Quality of Life / Q000523:psychology