Palliative care for older people with dementia — we need a paradigm shift in our approach

Older people with dementia have multiple palliative care needs, with pain, agitation, dyspnoea, aspiration and pressure ulcers being common and persistent in advanced dementia. Anticipating the person’s possible symptoms requires knowledge of the whole person, including the type of dementia, which is problematic when the dementia type is often not documented. A palliative care approach to dementia should look at symptoms across the four pillars of palliative care, but in reality, we tend to over-focus on physical and psychological symptoms, while spiritual and emotional needs can be overlooked, especially around the time of diagnosis, where such needs may be significant. Advance care planning (ACP) is a central tenet of good dementia palliative care, as the person may lose their ability to communicate and make complex decisions over time. Despite this, care planning is often approached too late, and with the person’s family rather than with the person; much of the literature on ACP in dementia is based on proxy decision-making for people in residential care. Thus, we need a paradigm shift in how we approach dementia, beginning with timely diagnosis that includes the dementia type, and with services able to assess and meet emotional and spiritual needs especially around the time of diagnosis, and with timely ACP as an integral part of our overall approach

The Transfer of Problem-Based Learning Skills to Clinical Practice

The purpose of this article is to present and discuss the reported impact of a fully problem-based learning (PBL) master’s program on the way graduates worked with patients and colleagues in Ireland. These graduates had completed a sixteen-month fully PBL master’s in sonography while concurrently working in clinical practice. Semi-structured telephone interviews were used to collect qualitative data from graduates of the PBL program. PBL graduates reported four notable changes in their approach to clinical practice following the PBL MSc ultrasound program: (1) thinking more before, during, and after clinical practice; (2) more effective communication with patients; (3) improved communication with colleagues; and (4) an increase in proactivity in clinical practice. The transfer of skills developed during the PBL program, as reported by sonography graduates, led to the development of more patient-centered, evidence-based, proactive clinical practice

A Move to Higher Module Credit Weighting to Enhance Student Engagement

Modularisation has supported great flexibility in curriculum pathways. However, there has been little guidance to staff on the module credit weighting that is optimum to allow for this flexibility without compromising student engagement. Student engagement can include, for example, student\u27s time and effort (workload), their participation, interest in the subject and their deeper learning. The UCD School of HIstory, with a standard module credit weighting of five ECTs credits, set out to move to 10 credit modules and to redesign for the enhancement of student engagement in their final year. Using a mixed-method approach, over a three year period student and staff views and experiences of the redesign were explored (n=187 module offerings). The themes identified are explored through the lens of Kahu\u27s (2013) student engagement framework, with evidence of increased engagement of students and staff satisfaction with the design change

People with dementia and family carers are welcoming of a model of dementia palliative care, but sceptical of its implementation

Introduction: A palliative care approach can improve quality-of-life for people with dementia. It is the preference of many people with dementia to remain living at home until death, with the appropriate care. To develop a successful model for dementia palliative care in the community, it is essential to assimilate the perspectives and experiences of those affected. The guiding research question for this study was: What are people with dementia and family carers’ views on a model for dementia palliative care? Methods: Focus groups (n=3) were conducted with bereaved or current family carers (n=11), and people with dementia (n=2). Discussions centred around a proposed model of dementia palliative care. These were transcribed and analysed using thematic analysis. Results: Three main themes were identified: living and dying well with dementia; reducing carer burden to fulfil the wish for home care; and lack of faith in the healthcare system. One statement which summarised the analysis was: “Dementia palliative care is a dream, but not a reality.” This reflected participants’ repeated “wish” for this “ideal” model of care, but simultaneous scepticism regarding its implementation, based on their prior experiences of healthcare services. Conclusion: All participants were welcoming of the proposed model for dementia palliative care and were generally positive about palliative care as a concept relating to dementia. There was consensus that the model would allow people to live and die well with dementia, and reducing the carer burden would fulfil the wish to remain at home. However systemic changes in the healthcare system will be needed to facilitate a truly person-centred, holistic, individualised and flexible model of care. <br/

A scoping review of the evidence for community-based dementia palliative care services and their related service activities

BACKGROUND: Palliative care is identified internationally as a priority for efficacious dementia care. Research into “effective models” of palliative care for people with dementia has been recommended by several European countries. To build an effective service-delivery model we must gain an understanding of existing models used in similar settings. The study aim is to identify core components of extant models of palliative care for people with dementia, and their families, who are living at home in the community. METHODS: A scoping review was employed. The search strategy was devised to identify all peer-reviewed research papers relating to the above aim. This process was iterative, and the search strategy was refined as evidence emerged and was reviewed. All types of study designs and both quantitative and qualitative studies of non-pharmacological interventions were considered for inclusion. RESULTS: The search identified 2,754 unique citations, of which 18 papers were deemed eligible for inclusion. Although a palliative care approach is recommended from early in the disease process, most evidence involves end-of-life care or advanced dementia and pertains to residential care. The majority of the research reviewed focused on the effects of advance care planning, and end-of-life care; specialist palliative care input, and/or generalist palliative care provided by dementia services to enable people to remain at home and to reduce costs of care. Community staff training in palliative care appeared to improve engagement with Specialist Palliative Care teams. Integration of dementia and palliative care services was found to improve care received for people with dementia and their carers. CONCLUSIONS: While the evidence for integration of dementia and palliative care services is promising, further high-quality research is necessary particularly to identify the key components of palliative care for people living with dementia. This is imperative to enable people with dementia to inform their own care, to stay living at home for as long as possible, and, where appropriate, to die at home. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-022-00922-7