dementia and palliative care Flashcards
when to consider palliative care in dementia PT
when diagnosed
- can be considered a teminal diagnosis
5 reasons to involve palliative care
- improve QOL
- decrease Sx burden
- less aggressive interventions at end of life
- improved satisfaction with care
- live longer
3 parts of palliative care lens
- burden of Sx
- functionality
- goals of care/ACP
when is most important point of palliative
last year
types of dementia Sx
- aggression
- confusion
- hallucination
- disinhibition
- irritable/labile
- insomnia
- depression
4 spheres of Tx
- environment
- psychosocial
- complementary
- PT
- massage - pharma
- PAIN MEDS
what is relationship between pain and dementia
- pain under-recognized and under treated
- pain can trigger and worsen Sx
- agitated PTs respond to pain meds alone
- those with pain have the worst depression
3 methods to measure pain
- pain scale
- faces
- PAINAD
- breathing
- vocal
- body lang
- facial expression
- consolability
risks and benefits of opiods
risks - falls - confusion - sedation benfit - less pain - less agitation
4 pain meds to use, and one not to
- aceto - 3g/day
- topical NSAID
- opiods - lower doses
- adjuvants
NOT
oral NSAID - renal
what is good measure of funcitonality
palliatve performace scale
3 parts of gold standard framework
- surprise question
- general indicators of decline
- specific indicators of decline
what are general indicators
- unstable, deteriorating complex Sx burden
- decreasing response to Tx
- > 10% weight loss
- repeated admissions
- albumin
specific indicators
- no meaningful conversation
- incontinence
- recurrent fever
- aspiration pneumos
- decreased oral intake
6 practical comprehensive goals of care
- be cured
- live longer
- improve/maintain function
- be comfortable
- provide support ot fam
- acheive life goals
what are 3 challenges to ACP
- discusses intensive therapies
- hard to predict what will want
- values change along the way - need to be flexible
what is evidence for feeding tube for nutrition, aspiration, life
nurtrition - doesn’t help
asp. - makes worse
life -extends by a day
** what is feeding tube reccomendation
NOT reccomended
4 non-pharma Tx of dyspnea
- reposition
- physio
- fan
- room air by cannula
what is effect of opiods on dyspnea
- reduces feeling of breathlessness
- does NOT cause resp. depression or death
2 other meds for dyspnea
- benzos
2. antipych
