A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia.
OBJECTIVE
This paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to end-of-life care in these patients.


BACKGROUND
In UK alone, approximately 100,000 people with dementia die each year and as the number of older people increases, dementia is set to become even more prevalent. Dementia is a progressive terminal illness for which there is currently no cure. Patients dying with dementia have significant health-care needs and in recent years it has been recognised that palliative care should be made available to everyone regardless of diagnosis, as this improves comfort and quality of life. Despite this, patients dying with dementia are often still not given access to palliative care services.


METHODS
A review of English language literature published after 1996 to the present day relating to older people with dementia during the terminal phase of their illness.


RESULTS
Twenty-nine articles met inclusion criteria for the review. Most originated from North America and UK and were mostly quantitative in nature. Four key themes were identified: difficulties associated with diagnosing the terminal phase of the illness (prognostication); issues relating to communication; medical interventions; and the appropriateness of palliative care intervention.


CONCLUSIONS
This review reinforces the importance of providing appropriate palliative care to individuals suffering from end-stage dementia and identifies some of the barriers to extending such specialist palliative care provision.


CONCLUSIONS
There is an urgent need to improve palliative care provision for older people with end-stage dementia and, in addition, more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end-of-life care.
Birch
Deborah
D
United Lincolnshire NHS Trust, Lincoln, Lincolnshire, UK.
Draper
Jan
J
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis / Q000191:economics / Q000451:nursing*; D006801:Humans; D033183:Interdisciplinary Communication; D010166:Palliative Care / Q000458:organization & administration*