Are we providing option of palliative care to people suffering from #AdvancedDementia?
We don't expect the dementia to reverse, however, we can work on improving Quality of life of those who can't communicate for themselves.
#Alzheimers @ompsychiatrist @dr_samirparikh
We don't expect the dementia to reverse, however, we can work on improving Quality of life of those who can't communicate for themselves.
#Alzheimers @ompsychiatrist @dr_samirparikh
The average life expectancy is around a year in advanced stages which get further reduced to weeks if they suffer from pneumonia/infections/ stroke/swallowing problems/cachexia/dehydration.
We need work on ⬇️their suffering and let them have dignity in last stages of life.
We need work on ⬇️their suffering and let them have dignity in last stages of life.
Common problems encountered:
1. Pain: This can be because of arthritis/constipation/infection and it can lead to exacerbation of depression/ behavioral problems. On top of that, they are unable to self report same due to communication problem/ memory problem.
1. Pain: This can be because of arthritis/constipation/infection and it can lead to exacerbation of depression/ behavioral problems. On top of that, they are unable to self report same due to communication problem/ memory problem.
It can be assessed by change in breathing pattern, vocalization, facial expression, body language. We can help in this by givin medicines while being cautious of side effects. Other options of massage, heating and cooling pads, rest,🎵, exercise, presence of other👱can also help.
2. Eating/drinking problems- it can manifest as keeping food in mouth, stop chewing, spitting out food and can lead to wt.loss/aspiration. May be due to advanced dementia or stroke/acute infection/pain/inadequate oral health/ dry oral mucosa due to medication side effects.
This can be helped by giving preferred food (sweet), finger food, giving food in upright position (to decrease risk of aspiration)
OPTION of percutaneous endoscopic gastrostomy tube provides NO BENEFIT.
OPTION of percutaneous endoscopic gastrostomy tube provides NO BENEFIT.
3. Breathlessness- may be due to pneumonia. Giving O2/ morphine/ hyoscine along with keeping the person in upright position, having fan on face, damp wipe may decrease the sensation of breathlessness.
4. Behavioral problems/ delirium/ sleep problems can be helped with medicines.
4. Behavioral problems/ delirium/ sleep problems can be helped with medicines.
5. Infections- Use of antibiotics esp. injectables along with repetitive invasive testing if needed, may be cautiously considered. There is generally poor evidence of same in improvin survival or quality of life.
Overtreating with aggressive surgical procedures must be avoided.
Overtreating with aggressive surgical procedures must be avoided.
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