Dementia Centred

By Henriette Laidlaw

January 29th, 2016

NICE Guidelines: Care of dying adults in the last days of life

The Care of dying adults in the last days of life guidelines have some specific advice relevant when caring for the patient with dementia.

Pain Management

The guidelines stress the importance of the use of validated behavioural pain assessment to inform pain management for someone with dementia.

Management of anxiety, delirium and agitation

People who are entering the last days of life may develop sepsis, dehydration and various biochemical disorders which may lead to the development of delirium. This is characterised by altering levels of consciousness, confusion and possibly hallucinations.

Many of the drugs used to control delirium are classed as sedatives. It can be difficult for inexperienced clinicians to reduce delirium without causing undue sedation. An inappropriately large dose of sedative medication may also compromise respiration. A perceived risk of over‑sedation is that the dying person's life may be shortened because of the sedation itself.

The guidelines state:

  • Explore the possible causes of anxiety or delirium, with or without agitation, with the dying person and those important to them. Be aware that agitation in isolation is sometimes associated with other unrelieved symptoms or bodily needs for example, unrelieved pain or a full bladder or rectum
  • Consider non‑pharmacological management of agitation, anxiety and delirium in a person in the last days of life.
  • Treat any reversible causes of agitation, anxiety or delirium, for example, psychological causes or certain metabolic disorders (for example renal failure or hyponatraemia).
  • Consider a trial of a benzodiazepine to manage anxiety or agitation.
  • Consider a trial of an antipsychotic medicine to manage delirium or agitation.
  • Seek specialist advice if the diagnosis of agitation or delirium is uncertain, if the agitation or delirium does not respond to antipsychotic treatment or if treatment causes unwanted sedation.

You will find the guidelines here: Care of dying adults in the last days of life

Categories: Nice Guidelines