Toward Gerineuropalliative Care for Patients with Dementia.
Toward Gerineuropalliative Care for Patients with Dementia.
复制标题
对痴呆症患者进行神经神经姑息治疗。
DOI：
10.1056/nejmp2301347
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Ritchie,ChristineS
中科院分区：
文献类型：
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作者：
Harrison,KristaL;Boyd,Nicole;Ritchie,ChristineS
如今，美国估计有 670 万 65 岁以上的人患有痴呆症，部分由 1100 万无薪护理人员照顾。 1 全球有超过 5500 万人患有痴呆症，每年诊断出 1000 万新病例。 2 新的抗淀粉样蛋白和新兴的抗 tau 蛋白疗法将注意力集中在痴呆综合征（一种进行性严重疾病）的早期筛查和诊断上。然而，在新疗法的同时，我们需要新的护理模式，以减轻痛苦，提高护理质量，并扩大对痴呆症患者及其护理伙伴的支持，这些目标与美国解决阿尔茨海默病国家计划3和世界卫生组织的痴呆症公共卫生应对全球行动计划相一致。 2为了实现这些目标，我们提出了一种治疗痴呆症的“老年姑息治疗”方法，该方法将老年病、姑息治疗和痴呆症护理的原则融入到护理的每个阶段和方面，无论所涉及的临床医生的学科如何（见图）。正如癌症治疗（例如免疫疗法）的进步提高了老年病学和姑息治疗在治疗整个人方面的重要性一样，鉴于潜在的繁重治疗方案和副作用、预后不确定性以及需要应对不协调的医疗保健，痴呆症疾病修饰治疗的出现使老年痴呆症姑息治疗变得更加紧迫。
Today, an estimated 6.7 million people over 65 years of age in the United States are living with dementia, cared for in part by 11 million unpaid care givers. 1 Globally, more than 55 million people have dementia, and 10 million new cases are diagnosed each year. 2 New anti-amyloid and emerging anti-tau therapies are focusing attention on early screening and diagnosis for dementia syndromes, which are progressive serious illnesses. In parallel with new treatments, however, we need new care models that can mitigate suffering, enhance care quality, and expand support for persons living with dementia and their care partners—goals that are aligned with the US National Plan to Address Alzheimer’s Disease3 and the World Health Organization’s Global Action Plan on the Public Health Response to Dementia. 2To achieve these goals, we propose a" gerineuropalliative” approach to dementia that would infuse principles from geriatric, palliative, and dementia care into every stage and aspect of care, regardless of the discipline of the clinician involved (see figure). Just as advances in cancer treatments (eg, immunotherapy) have increased the salience of geriatrics and palliative care for treating the whole person, the advent of disease-modifying treatments for dementia makes gerineuropalliative dementia care more pressing, given potentially burdensome treatment protocols and side effects, prognostic uncertainty, and the need to navigate discoordinated health care.