Palliative Care in Dementia Patients

This assignment delves into the crucial topic of palliative care in dementia patients. It examines various research articles that shed light on nurses' understanding of pain assessment, the role of palliative care coordinators in facilitating family discussions, and the importance of symptom management for dementia patients in acute hospital settings. The analysis also considers the knowledge gaps among different stakeholders, including nurses, care workers, and family members, emphasizing the need for improved education and support.

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the Student:
Name of the University:
Author Note:

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Assessment task 1
Essay
Introduction
End of life care is particularly challenging for the healthcare professionals as it requires
extensive collaboration and critical insight to ensure health and wellbeing of the distressed
individuals in need of care. In contrast to the terminally ill patients who require palliative care
services for management of their condition, the ones afflicted by dementia like disorders is
shrouded with impediments that hamper their quality of life significantly. Dementia has been
identified as a debilitating syndrome that causes progressive deterioration of the cognitive brain
functioning encompassing memory, perception, reasoning, understanding and behavior. The
geriatric population is more vulnerable to acquire this condition and majority of the incidences
reportedly occur at age 65 years or more (World Health Organization, 2017). Data in the context
of Australia for the year 2014 has revealed that dementia including Alzheimer’s disease is the
second leading cause of death accounting for 7.8% of total mortalities in Australia (Abs.gov.au,
2017). In consideration of the above situation it is imperative to resort to prudent approaches as
offered through palliative care facilities for enhancing the prevalent scenario with respect to the
dementia patients living in Australia. The following essay will highlight on three relevant issues
that might hinder the provision of person-centered and family focused palliative care for older
people living with end-stage dementia in residential aged care facilities in Australia itself.
Issues that may hinder the provision of person-centered and family focused palliative care for
older people living with end-stage dementia in residential aged care facilities in Australia

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Rendering person-centered and family focused palliative care for older people thriving
with end-stage dementia in case of aged care facilities may be disrupted due to pervasiveness of
various issues such as paucity of access to palliative care, communication problems and faulty
pain management. These issues impede the proper management of the deleterious health
condition of dementia that tends to rob oneself of her personal stand.
Lack of access to palliative care
Dementia is a potentially debilitating illness in which the declining cognitive status of the
affected person majorly influences the judgment, reasoning, memory and communication skills
thereby posing threat to the victims. Hence, providing adequate and most appropriate treatment
intervention is a challenging task for the healthcare professionals. Moreover, end stage dementia
is particularly hard to handle due to insufficient and considerable knowledge acquisition on the
part of healthcare professionals in addition to limited resources and dearth of curative therapies.
Transcending the traditional care with respect to dementia patients, novel and improved
healthcare practices are required to remedy the sufferings of the dementia affected patients as
well as their families thereby providing opportunities for maximizing the quality of life of them
across various stages of illness. Poor outcomes because of end of life issues in dementia patients
is of particular botheration as it tend to jeopardize the stability in a person’s life and incur threats
to health (Lee et al. 2017). Further, researches carried out with respect to the provision of end-of-
life care depicted that despite being a terminal illness condition; dementia is often undermined
that leads to inadequate healthcare delivery. People with end stage dementia do not have access
to most suited end-of-life care needs that compromise their healthcare outcomes in a major way.
In contrast to other terminal illness, stereotype and stigma is attached with dementia that makes it
more difficult to combat the adverse outcomes. Difficulty in dementia diagnosis coupled with

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lack of education regarding the disorder by the healthcare workforce, families and caregivers
predisposes the vulnerable group of elderly population to encounter the wraths and negative
repercussions. Inability to detect complications associated with end stage dementia by the
healthcare professionals further aggravates the problem and harness poor end-of-life outcomes to
strategize suitable interventions based on the individualized needs of the affected dementia
person. The composite needs of the victims are not succinctly addressed due to such negative
results emanating from dearth of clinical expertise and insight for recognizing the specific
symptoms of dementia. Fewer referrals to suitable palliative care facilities are another major
hindrance (Dowling et al. 2015). The culturally, linguistically and ethnically diverse groups are
particularly susceptible to face discrimination in terms of access to healthcare and equity in
service provision. Therefore, timely diagnosis and prompt intervention are delayed that
procrastinates the chances of recovery of the dementia patient in a huge manner. Adequate
navigation of the healthcare system if not fulfilled satisfactorily has the ability to diminish the
service outcomes for dementia patients in spite of exhibition of similar symptoms like that of
pain, confusion, agitation, lack of sleep and eating as happens in terminal illness like cancer
(King, Goeman and Koch 2015).
Communication issues
In contemporary healthcare sector, communication is considered crucial and
complementary to other modes of therapeutic interventions for deriving optimal benefits for the
distressed patient. In case of dementia-affected patients, similar results may be expected out of
appropriate following of communication strategies. The affected individuals may not always
verbally articulate sufferings instead, they may resort to expressing their issues of concern
through behavioral gestures and similar symptoms. Functional decline of the dementia sufferers

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is commonly noted that may be indicative of the diagnostic presence of dementia in the
concerned individual. Thus, the general practitioners through cooperative and synergistic efforts
received from other allied healthcare professionals are capable of rendering accurate diagnosis
and management for dementia. Empirical evidences have offered resolution in mitigating the
challenging issues with respect to the dementia patients through undertaking of proper training,
encouraging the dementia-affected to continue with exercise programs, healthy dietary intake
and self-sufficient activities of daily living as much as practicable. Therefore, understanding the
underlying symptoms through critical reflection is important for the health service providers to
address the situation satisfactorily and has been categorically stated in the clinical practice
guidelines for elderly dementia patients (Dyer et al. 2016). Apart from the healthcare workers,
the family members who remain in close association with the patient might also encounter
challenges to comprehend the immediate situation that indicate the behavioral underpinning
linked to dementia. The healthcare prioritization of dementia like condition have garnered
considerable attention in recent circumstances that further necessitated the need to incorporate all
the elements surrounding dementia care to harbor positive outcomes. Emphasis has been
attached to consider revision of caregivers’ needs in liaison with the cultural values for reducing
the subjective burden associated with dementia. The caregiver support mechanisms has been
suggested to rest in conformity with the allied concepts of dementia care for prudent intervention
regarding the matter. The ability to listen, respond and construe depending on the patient’s
situation has been identified particularly important (Xiao et al. 2014). Better communication and
comprehension of the non-verbal behavioral responses is likely to ensure the smooth
implementation of the therapeutic interventions aimed to ameliorate the symptoms of the
dementia patient. Non-verbal communication has been recognized as the most suitable

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therapeutic target through psychological intervention models within the delivery care framework.
Specifically dementia and Alzheimer’s disease has been reportedly lead to the generation of
improved outcomes through utilization of various technological resources so that communication
between people with dementia and their caregivers presents significant transformation (Chenery
et al. 2016). The inability to voice their feelings or express with the help of words should not
stand on the way of offering appropriate health service to the patient, instead behavioral
responses and facial expressions must be taken into consideration while assessing the dementia
condition for the concerned affected person. The changing behavioral pattern in course of
progressive stages of dementia need to be kept into account by the attending healthcare
professionals to deal with the ensuing situation perfectly. Study findings suggest that increased
education in addition to support for families circumscribing issues pertinent to end-of-life care
decisions is fruitful for advanced dementia. In case, the patients do not have the capacity to take
decisions about treatment modalities in end of life, the same must be entrusted upon the near
ones of the patient comprising of family members preferably. The necessary decisions on
patients’ behalf will be taken by that concerned individual, which is to be clearly defined in
statements surrounding advanced care planning where explanations for choices in end-of-life
care will be documented (Reinhardt et al. 2014).
Pain management
There has been speculation regarding the use of analgesic medications in case of the
dementia-affected individuals that has largely accounted for the reduced use of pain reliving
medicines in case of such patients. Improper and decreased pain management is thus noticed.
Effective treatment faces barriers in absence of successful communication of pain for severe
dementia. Systematic study of facial expressions has brought to the forefront distinguished

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characteristics specific to the perception of pain that hold potential for future implication to
alleviate dementia symptoms through proper therapeutic administration. The reliable indicators
of pain has been found to be confounded by factors such as contextual variables, observer’s bias
in addition to overall state of the individual’s health and wellbeing. Thus, the susceptibility to
pain by the elderly individuals is likely to be resolved by allaying the possibilities of under-
recognition, under-treatment and under-estimation (Hadjistavropoulos et al. 2014). Issues like
that of grimacing pain because of progressive illness that cause significant decline of their health
status compound dementia patients approaching end of life. The healthcare assistants recruited at
the aged care facilities spend a bulk proportion of time with the ailing patients as opposed to
other healthcare personnel thereby acting as the frontline healthcare workforce responsible for
offering accurate healthcare service to the dementia patients. They conduct the operations related
to identification of pain in the dementia-affected persons and reporting to the immediate
authority for prompt medical intervention. Literature has supported the up skilling of this group
of healthcare team members and reversal of the stigma attached to the role to render safe and
quality dementia care for the concerned persons (Jansen et al. 2017). Targeted pain management
services through incorporation of relevant pain assessment tools has been highlighted in further
study to allow better understanding in relation to the prescribing practices within the aged care
facilities thereby accounting for improved quality of life for those affected persons (Tan et al.
2014). Healthcare staff and informal caregivers who remain in close proximity with the dementia
afflicted patients in the aged care facilities exhibit attitudinal and knowledge barriers in
assessment of pain that threaten the status of those persons because of exerting significant
influence over practice behaviour. Thus, discernible attention and prudent intervention with
respect to pain management through knowledge and other skills acquisition is desirable to elicit

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positive responses through better pain handling in the dementia patients during their end-of-life
care (Chandler et al. 2017).
Critically analyses
Management of dementia in aged care facilities calls for greater insight, prudence and
pragmatism through utilization of suitable multidimensional composite healthcare interventions
that are capable of eliciting positive results on application. A team comprising of
interdisciplinary healthcare members may undertake measures that properly address the needs of
the dementia patients so that quality of life of both patient as well as caregiver may be improved.
Prognosis, management and advanced care planning for the dementia patients are likely to
culminate in generating holistic outcomes that will cause emancipation of the individual’s health
in addition to assessing their palliative care needs (Brody 2016). Delivery of effective dementia
care planning has been found to be thwarted due to poor symptom assessment alongside possible
inappropriate prescription of antipsychotic medication that may be further attributed to the
lacunae in understanding and knowledge in managing dementia patients by the healthcare
workers during their clinical intervention (O’Shea et al. 2015). Deeper probe into matters
relevant to the dementia patients have referred to both the under-treatment and under-recognition
of pain among the elderly dementia patients. The deficits in nursing knowledge and attitudes
owing to the complexity and individualization with respect to pain behaviors have been held
responsible for such implications. However, a standardized approach to pain management in
conjunction with workforce stability and accessibility of proper training for the nurses might lead
to successful management of pain in case of dementia patients (McIlfatrick 2015). Further,
critical appraisal of dementia patient condition has talked about implementation of a facilitated
approach to better equip with relevant resources essential to deal with older patients suffering

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from dementia. A collaborative nursing home culture supported by activities and ongoing
associations for the healthcare workers is desirable to ensure safe and quality healthcare facility
for dementia affected, palliative care patients (Luckett et al. 2017).
Recommendation
Positive healthcare outcomes specific to the elderly dementia patients may be represented
through access to palliative healthcare services in residential aged care settings where the nurses
and other healthcare staff make endeavors to render all round support for managing their
condition. Information available in the context of Australia suggest that the escalating numbers
of dementia diagnosed patients require extensive care in the form of palliative care services as
accessible in the aged care facilities to ameliorate their declining health status symptoms
(Aihw.gov.au, 2017). Empirical evidences have argued in favor of improvising and
implementing appropriate interventions for the sake of addressing the end-of-life care services
specific to the dementia patients that aim to harp on matters related to the challenges in course of
the illness and trajectory. In conjunction with the interactive responses, the non-verbal
communication has been considered crucial to better manage the condition besides being heed to
the sufferings of the caregivers who remain in close association with the patients (Rexach2012).
Apart from the traditional modalities of dementia management, it has been increasingly
emphasized to recover the knowledge deficits and apply relevant learning, desirable skills
regarding palliative care management of dementia patients among the healthcare workers and
families of patients surviving with dementia that may be enhanced through evidence based
practice. Palliative care has been identified as a potential way of managing dementia to live up to
the heightened demands of optimal care for dementia afflicted (Robinson et al. 2014). Further,
recommendations have highlighted on maintaining the ethical and legal standards of practice in

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nursing for safeguarding the choices, autonomy and dignity of the patients by means of
providing insight pertaining to advanced care planning (ACP) that in turn may be facilitated
through arranging training sessions for the concerned healthcare professionals in charge of
dementia affected patients (Health.gov.au, 2017).
Conclusion
Critical evaluation of the condition prevalent among the dementia patients receiving end
of life care has brought to the forefront the barriers to management of such individuals within the
residential setting framework of palliative care unit. Until date no cure for dementia has been
discovered, however alleviation of the symptoms associated with the disorder has been found to
be effective in tackling the situation specific to the patient. Therefore, it must be ensured so that
they get access to specialized palliative care health services at par with others suffering from
terminal illness. Accurate assessment and interpretation of the patient situation carried out by the
nurses and other healthcare personnel is crucial to treat them holistically by catering to their
individualized needs. Pragmatic observation of both the verbal as well as nom-verbal
communication is beneficial in this respect where the nurses may satisfactorily acknowledge the
distinctive scenario. Further, the pain management regime needs to be well monitored and
comprehensive to prevent adverse outcomes and ensure better quality of life for the dementia
affected old. Overall the end of life care for dementia patients needs to be framed in coalition
with inputs received the respective healthcare professionals, the patient and their families so that
all aspects of health including the physical, emotional, spiritual, as well as cultural domains is
addressed for harboring optimal outcomes.

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