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A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia

Published online by Cambridge University Press:  05 April 2005

E. L. Sampson ,
C. W. Ritchie ,
R. Lai ,
P. W. Raven  and
M. R. Blanchard
E. L. Sampson
Affiliation:
Metabolic and Clinical Trials Unit, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, U.K.
C. W. Ritchie
Affiliation:
Metabolic and Clinical Trials Unit, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, U.K.
R. Lai
Affiliation:
University Library, Royal Free Campus, Royal Free and University College Medical School, London, U.K.
P. W. Raven
Affiliation:
Metabolic and Clinical Trials Unit, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, U.K. Camden and Islington Mental Health and Social Care Trust, London, U.K.
M. R. Blanchard
Affiliation:
Metabolic and Clinical Trials Unit, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, U.K. Camden and Islington Mental Health and Social Care Trust, London, U.K.
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Abstract

Background: Patients with dementia often receive poor end-of-life care, with inadequate pain control and without access to the palliative care services that patients with cancer are offered. This has been identified as an area of need in recent U.K. Government reports and by the Alzheimer's Society (U.K.). Our objective was to perform a systematic review of the scientific literature regarding the efficacy of a palliative care model in patients with dementia.

Methods: A systematic review was carried out to identify controlled trials that investigated the efficacy of palliative care in patients with dementia. Data sources included were Medline, EMBASE, PsycINFO, CINAHL, British Nursing Index, AMED, Cochrane Database of Systematic Reviews, Web of Science, Cochrane Central Register of Controlled Trials, International Standard Randomised Controlled Trial register, the NHS Economic Evaluation Database and the System for Information on Grey Literature in Europe. Other data was sourced from hand searches of papers identified on electronic databases and review articles.

Results: The search identified 30 review articles, but only four papers were eligible for full appraisal and only two of these met the full criteria for inclusion. These papers gave equivocal evidence of the efficacy for a palliative model of care in dementia.

Conclusion: Despite the increased interest in palliative care for patients with dementia there is currently little evidence on which to base such an approach. This may in part be due to the ethical difficulties surrounding such research, prognostic uncertainty in clinicians and the lack of clear outcome measures for patients who are unable to express their needs or wishes. Further systematic research is urgently needed to educate an important and developing area of clinical practice.

Keywords

Alzheimer's diseasedementiapalliative careend-of-life careterminal caresystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 17 , Issue 1 , March 2005 , pp. 31 - 40
Copyright
International Psychogeriatric Association 2005

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