Dementia Clinical Trial
Official title:
Palliative and End-of-life Care in Advanced Dementia: Evaluation of a Program of Organization of Care in Long-term Care Settings
Rationale: In Canada, as in most industrialized countries, Alzheimer's disease and other
related dementia are increasingly prevalent in older people. At an advanced stage,
institutionalization in a long-term care (LTC) setting will be the fate of a majority of
patients. A structured palliative care approach is increasingly used for cancer patients,
but is still rarely accessible in LTC institutions for older people with advanced or
terminal dementia. This approach should include a more systematic detection and treatment of
pain and other physical and psychological symptoms during the last weeks of life, as well as
better communications between patients, families and care staff, particularly relating to
advanced care directives. Objectives: The general objective of this study is to implement
and evaluate a multidisciplinary and multidimensional program of palliative and end-of-life
care for older persons with terminal dementia in LTC facilities. Methodology: The
intervention program will include five components:
1. daily involvement of a nurse from the regular staff in the LTC facility as a change
agent;
2. awareness sessions with administrators and staff on the importance of high quality
palliative care in dementia;
3. a training program for physicians and all the staff involved in direct care of
patients;
4. systematic discussions with families and distribution to families of a document on
different aspects of palliative care in dementia;
5. systematic clinical care by regular staff for the control of pain, respiratory symptoms
and mouth care. The program will be implemented in two LTC settings (one in Quebec City
and one in Sherbrooke, Quebec, Canada), and results will be compared with the LTC
control settings where usual care will be applied without implementation of the
program.
n/a
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