Advanced dementia: an integrated homecare programme.

Autor:	Hum A; Palliative Medicine, Tan Tock Seng Hospital, Singapore.; The Palliative Care Centre for Excellence in Research and Education, Singapore.; Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore.; Education and Research, Dover Park Hospice, Singapore., Tay RY; The Palliative Care Centre for Excellence in Research and Education, Singapore riyin_tay@doverpark.sg.; Education and Research, Dover Park Hospice, Singapore., Wong YKY; Epidemiology, Singapore Clinical Research Institute, Singapore., Ali NB; Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore., Leong IYO; Integrative and Community Care, Tan Tock Seng Hospital, Singapore., Wu HY; Palliative Medicine, Tan Tock Seng Hospital, Singapore.; The Palliative Care Centre for Excellence in Research and Education, Singapore., Chin JJ; Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore.; Integrative and Community Care, Tan Tock Seng Hospital, Singapore., Lee AOK; Medical, St. Andrew's Community Hospital, Singapore., Koh MYH; Palliative Medicine, Tan Tock Seng Hospital, Singapore.; The Palliative Care Centre for Excellence in Research and Education, Singapore.; Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	BMJ supportive & palliative care [BMJ Support Palliat Care] 2020 Dec; Vol. 10 (4), pp. e40. Date of Electronic Publication: 2019 Jun 25.
DOI:	10.1136/bmjspcare-2019-001798
Abstrakt:	Objectives: We established an integrated palliative homecare programme for advanced dementia. This study explores patients' symptoms and quality-of-life and their association with enteral feeding, evaluates the impact of the programme on these parameters and examines familial caregiver burden. Methods: This is a prospective cohort study. Patients at Functional Assessment Stage 7, with an albumin level <35 g/L, pneumonia or enteral feeding were recruited. At baseline and regular intervals, the multidisciplinary homecare team used the Pain Assessment in Advanced Dementia, Mini Nutritional Assessment and Neuropsychiatric Inventory Questionnaire (NPI-Q) to identify patients' symptoms, and the Quality of Life in Late-Stage Dementia (QUALID) tool to assess quality-of-life as primary outcomes, stratified by feeding status. The Zarit Burden Interview (ZBI) investigated caregiver burden, stratified by living arrangement and availability of stay-in help. Mann-Whitney U and χ 2 tests compared continuous and categorical variables respectively between groups while Wilcoxon signed-rank test compared assessment scores at baseline and on review. Results: At baseline, 49.2% of the 254 patients had pain, 92.5% were malnourished and 85.0% experienced neuropsychiatric challenges. Patients on enteral feeding had lower NPI-Q score (median=3; IQR 1-6) than orally fed patients ((median=4; IQR 2-7), p=0.004) and higher QUALID score (median=25; IQR 21-30 vs median=21; IQR 17-25 for orally fed patients), p<0.0001, indicating a better quality-of-life for orally fed patients. Both symptoms and quality-of-life improved significantly for the 53 patients reviewed at the fifth month. Median ZBI score for caregivers was 26 (IQR 15-36). Having stay-in help reduced it from 39.5 (IQR 25-49) to 25 (IQR 15-35), p=0.001. Conclusion: An integrated multidisciplinary palliative homecare team with geriatric training that is accessible all-hours addressed the needs of home-dwelling patients with advanced dementia, improved their quality-of-life and supported families to care for them at home. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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