Mary’s Care Needs Progress

• Mary’s dementia progressed and she now needs 24 hour residential care.

• She develops behavioural difficulties in residential care, and stops eating.

What contribution does general practice have for aged residential care?

Do you think families understand the dementia trajectory?

Who sets the care goals?

Dementia Care Planning

Communication and collaboration with loved ones is the most important

Advanced Dementia Clinical Course

(Mitchell, et al., 2009) Pneumonia, febrile episodes, and eating problems are

frequent complications in patients with advanced dementia,

complications are associated with high 6-month mortality rates

Residents with Families that understood likely complications had less hospitalisations

Important considerations for a palliative approach to Dementia Care

Quality of life, comfort and wellbeing are the right of every elderly person facing the last years of life.

Life limiting disease can cause discomfort and pain

The right of every individual to determine their care and treatment

Australian Palliative Care Approach Guidelines

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/palliativecare-pubs-workf-guide.htm

MNANutrition Assessment

Score:

Score:

Score:

Score:

Score:

Score:

Has food intake declined over the past 3 months due to loss of

appetite, digestive, problems, chewing or swallowing difficulties?0 = severe loss of appetite1 = moderate loss of appetite2 = no loss of appetite

Weight loss during last months?0 = weight loss greater than 3 kg1 = does not know2 = weight loss between 1 and 3 kg3 = no weight loss

Mobility?0 = bed or chair bound1 = able to get out of bed/chair but does not go out2 = goes out

Has suffered physical stress or acute disease in the past 3 months?

0 = yes1 = no

Neuropsychological problems? 0 = severe dementia or depression 1 = mild dementia 2 = no psychological problems

Body Mass Index (BMI) {weight in kg} / [height in m] 0 = BMI < 19 1 = BMI 19 to < 21 2 = BMI 21 to 23 3 = BMI > 23

Screening score (total max 14 points):>12 – normal, not at risk, no need to complete assessment<11 – possible malnutrition – continue to assessment

Depression, Psychosis and other behavioural & Psychological Sx. (BPSD)

Antipsychotics Only use for:

severe agitation, psychomotor behaviour, hallucinations, paranoia, behavioural problems associated with dementia

Do not prescribe for: wandering, pacing or on PRN basis

Increases mortality

The Way Forward

Hancock K, Chang E, Johnson A et al (2006) Alzheimer’s Care Quarterly 7(1): 49–57