Dementia Centred

Lynn Kennedy's picture

By Lynn Kennedy

October 19th, 2016

Dementia and Palliative Care

The Marie Curie organisation describes both palliative and end of life care as: ‘Palliative care is for people living with a terminal illness where a cure is no longer possible. It aims to treat or manage pain and other physical symptoms. It will also help with any psychological, social or spiritual needs. Palliative care includes caring for people who are nearing the end of life.’

‘End of life care is an important part of palliative care. It is for people who are considered to be in the last year of life, but this timeframe can be difficult to predict. End of life care aims to help people live as well as possible and to die with dignity.’

It is recognised that people dying from advanced dementia have surprisingly comparable needs to those dying from advanced cancer. Yet people dying from advanced dementia are more likely to: 

  • die in an acute hospital ward or care home
  • have uncomfortable aggressive treatments prior to death

They are also less likely to:

  • be prescribed appropriate analgesia
  • have spiritual needs addressed
  • have an advanced care plan

How can this be? 

Non-cancer diagnoses are very under-represented in specialist palliative care services and workload. This could partly be due to the lack of recognition of dementia as a terminal illness and its uncertain prognosis. This is compounded by the national rates of diagnosis of dementia within the UK. . At present the UK rates of diagnosis of dementia ranges from 43.4% to 67% between all four countries. (House of Commons Library, 2016)

The Scottish Government's ‘Strategic Framework for Action on Palliative and End of Life Care 2016 – 2021 states:

‘By 2021, everyone in Scotland who needs palliative care will have access to it’

This is a bold vision and one we should indeed be achieving, although there may be some complexity in meeting this. Identification of people who may benefit from palliative care would need to improve, and improve considerably, if we are to ensure all those who would benefit from palliative care would indeed have access to it. 

Palliative Care Challenges in Dementia Care

Carers providing palliative care to people with dementia face dilemmas. These can include:

  • Differentiating between an aggressive medical approach and a palliative approach
  • Assessing and managing pain and other symptoms
  • Effective communication about end of life issues
  • Families’ perceptions
  • Resuscitation (DNAR)
  • Antibiotic use
  • Artificial rehydration
  • Admission to acute hospital
  • Use of psychoactive drugs

We have to ask ourselves when it comes to palliative/end of life care could dementia care learn lessons from cancer care? I think we know the answer to that one….

DSDC has developed the Best Practice in Dementia Care programme to help you achieve national and regional care standards. The programme not only meets these standards but is accredited by the Royal College of Nursing and City & Guilds

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