title: Symptom Assessment for a Palliative Care Approach in People With Dementia Admitted to Acute Hospitals: Results From a National Audit.
abstract: BACKGROUND
  As the prevalence of dementia increases, more people will need dementia palliative and end-of-life (EOL) care in acute hospitals. Published literature suggests that good quality care is not always provided.
  
  
  OBJECTIVE
  To evaluate the prescription of antipsychotics and performance of multidisciplinary assessments relevant to palliative care for people with dementia, including those at EOL, during hospital admission.
  
  
  METHODS
  As part of a national audit of dementia care, 660 case notes were reviewed across 35 acute hospitals.
  
  
  RESULTS
  In the entire cohort, many assessments essential to dementia palliative care were not performed. Of the total sample, 76 patients died, were documented to be receiving EOL care, and/or were referred for specialist palliative care. In this cohort, even less symptom assessment was performed (eg, no pain assessment in 27%, no delirium screening in 68%, and no mood or behavioral and psychological symptoms of dementia in 93%). In all, 37% had antipsychotic drugs during their admission and 71% of these received a new prescription in hospital, most commonly for "agitation."
  
  
  CONCLUSIONS
  This study suggests a picture of poor symptom assessment and possible inappropriate prescription of antipsychotic medication, including at EOL, hindering the planning and delivery of effective dementia palliative care in acute hospitals.
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland emma.oshea@ucc.ie.
authors.forename: Emma
authors.initials: E
authors.lastname: O'Shea
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Kennelly
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Anna
authors.initials: A
authors.lastname: de Siún
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Gallagher
authors.affiliation: Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland.
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Neill
mesh_terms: D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003693:Delirium / Q000150:complications / Q000175:diagnosis; D003704:Dementia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D010146:Pain / Q000150:complications / Q000175:diagnosis; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods / Q000592:standards; D010343:Patient Admission; D063189:Symptom Assessment; D013727:Terminal Care / Q000379:methods / Q000592:standards
chemical_list: D014150:Antipsychotic Agents
keywords: acute hospital; assessment; dementia care; end-of-life care; palliative