General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

Service and support requirements of people with younger onset dementia and their families final report, August, 2012

In 2011, Alzheimer’s Australia NSW (AlzNSW) was engaged by Ageing, Disability and Home Care (ADHC) to research the service and support requirements of people with younger onset dementia and their families in New South Wales. AlzNSW partnered with the Social Policy Research Centre (SPRC) and UnitingCare Ageing to conduct the research. This report outlines the methods, findings and policy implications of the research. Dementia is a major cause of disability amongst older people and some younger people aged under 65 years, causing ‘progressive change and degeneration in cognitive mental functions, such as memory, language, rational thinking and social skills, as well as behaviour, emotion and personality’ (Mocellin, Scholes and Velakoulis, 2008:1). Younger onset dementia is defined as dementia which occurs before the age of 65 years and under 50 years for Aboriginal people.   *Other authors - Ariella Meltzer, Karen R Fisher, Denise Thompson and Robyn Fain

Mental health nurses’ medicines management role: a qualitative content analysis

Aim: This study explores medicines management role undertaken by mental health nurses (MHN) in a wide variety of clinical specialisms and contexts. Method: Ten MHNs were interviewed and audiotaped. Qualitative content analysis of the transcribed interviews was undertaken. Results: These findings evidenced the wide ranging skills and knowledge the MHN utilizes when psychotropic medication is prescribed, and how they engage with service users and other practitioners. Four themes emerged that illustrated how the participants undertook such interventions: Medicines management in context; Managing time; Knowledge and skill used; Collaboration with other healthcare providers. Medicines management thus needs a greater emphasis in order for the for service users from the drugs they are prescribed achieves the optimum outcome

Better Palliative Care for Older People

Most deaths in European and other developed countries occur in people aged over 65, but relatively little health policy concerns their needs in the last years of life. As life expectancy increases, the number of people living to older ages is also increasing in many countries. At the same time, the relaive number of people of working age is declining and he age of potential caregivers is increasing. Palliatve care is therefore of growing public health importance. Older people have traditionally received less palliative care than younger people and services have focused on cancer. This booklet is part of the WHO regional Office for Europe's work to present evidence for health policy - and decision-makers in a clear and understandable form. It presents the needs of older people, the different trajectories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effecive palliative care solutions, and issues for the future

Creating Excellence in Dementia Care: A Research Review for Ireland's National Dementia Strategy

Examines the prevalence and economic and social costs of dementia; policies, practices, and data on health and social care services in community-based, acute care, and long-term residential settings; and proposed elements for a new strategy