Palliative and end of life care for people with dementia: lessons for clinical commissioners
Palliative and end of life care for people with dementia: lessons for clinical commissioners
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痴呆症患者的姑息治疗和临终关怀：临床专员的经验教训
DOI：
10.1017/s146342361300039x
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
S. Iliffe
中科院分区：
文献类型：
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作者：
Mareeni Raymond;A. Warner;N. Davies;N. Nicholas;J. Manthorpe;S. Iliffe
目的 使用综述论文综合有关痴呆症患者临终关怀管理的信息。背景 全球范围内被诊断患有痴呆症的人数不断增加，痴呆症患者及其护理人员在临终时的需求可能与其他慢性病患者不同。通过强调痴呆症患者姑息治疗所面临的挑战以及最佳管理方式，初级保健从业者也许能够在生命终结时改善为这群人提供的服务。方法 使用与姑息治疗和痴呆症相关的广义术语对 2000 年至 2011 年同行评审期刊上发表的英语论文的电子数据库进行检索。共鉴定出 6167 篇论文。阅读了标题和摘要。如果论文是对痴呆症/帕金森病/路易体痴呆/认知障碍/阿尔茨海默病或任何其他认知障碍患者的姑息治疗或临终关怀的文献综述，在任何环境（医院、疗养院、社区）并涵盖所有年龄段的人，则论文将被纳入。如果论文涉及针对其他病症的姑息治疗，或者涉及与姑息治疗无关的痴呆症护理和治疗的某个方面，则被排除在外。结果 我们的批判性综合从本次评论回顾中得出了五个主题：(1) 照顾者（家庭照顾者）的经验； (2) 以人为本的护理； (3) 实践（包括预先护理计划、疼痛和舒适、营养、医疗并发症和尽量减少行为症状的痛苦）； （4）系统因素，包括道德困境、决策、信息和培训； (5) 研究重点。关于痴呆症患者临终关怀和管理似乎有充分的证据，这些证据可用于影响政策制定和痴呆症患者姑息治疗实践中研究重点的新特点。
Aim To synthesize information about management of end of life care in people with dementia using review papers. Background There are increasing numbers of people being diagnosed with dementia worldwide, and the needs of people with dementia and their carers at the end of life may be different from those with other chronic diseases. By highlighting the challenges of palliative care in persons with dementia and the ways they are best managed, practitioners in primary care may be able to improve services for this group of people at the end of life. Methods A search of electronic databases of English language papers published in peer-reviewed journals, 2000–2011 inclusive was undertaken using broad terms related to palliative care and dementia. 6167 papers were identified. Titles and abstracts were read. Papers were included if they were literature reviews of palliative or end of life care for people with dementia/Parkinson's disease/Lewy body dementia/cognitive impairment/Alzheimer's disease or any other cognitive impairment, in any setting (hospital, care home, community) and covering people of all ages. Papers were excluded if they covered palliative care focusing on other conditions, or were about an aspect of dementia care and treatment not related to palliative care. Findings Our critical synthesis generated five main themes from this review of the reviews: (1) carers’ (family caregivers’) experiences; (2) person-centred care; (3) practice (including advance care planning, pain and comfort, nutrition, medical complications and minimizing the distress of behavioural symptoms); (4) system factors, including ethical dilemmas, decision making, information, and training; and (5) research priorities. There appears to be good evidence on the care and management of patients with dementia at the end of life which can be used to influence policy development and emerging specificity about research priorities in palliative care practice for people with dementia.