Challenges for professional care of advanced dementia.
Qualitative methodology based on action research identified challenges when caring for persons with advanced dementia, as perceived by key professional providers. Data collection was via five focus groups (total n = 24) and 20 follow-up individual interviews. Participants included palliative care, aged care and dementia specialist nurses, medical specialists from an area health service, residential aged care staff and general medical practitioners. Responses emphasized the need for improved knowledge and skills, and clearer policy. Concerns included accurate assessment, especially of pain, owing to the inability of people with advanced dementia to communicate their symptoms. Assessment, managing physical and behavioural symptoms, and communicating with family presented as further challenges. Conclusions are that the need for a palliative approach to care in advanced dementia should be recognized. Aged care staff can deliver palliative care to people with advanced dementia only if the staff receive relevant education and training beyond their generalist competencies.
Chang
Esther
E
School of Nursing and Midwifery, College of Social and Health Sciences, University of Western Sydney, Sydney, Australia. e.chang@uws.edu.au
Daly
John
J
Johnson
Amanda
A
Harrison
Kathleen
K
Easterbrook
Sally
S
Bidewell
John
J
Stewart
Heather
H
Noel
Michael
M
Hancock
Karen
K
D032722:Advance Care Planning; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D003704:Dementia / Q000150:complications / Q000517:prevention & control* / Q000523:psychology; D005190:Family / Q000523:psychology; D005194:Family Practice / Q000458:organization & administration; D017144:Focus Groups; D005851:Geriatric Nursing / Q000458:organization & administration; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D009517:New South Wales; D009730:Nursing Assessment; D009735:Nursing Homes / Q000458:organization & administration; D015404:Nursing Methodology Research; D010166:Palliative Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D036301:Qualitative Research; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires