Mary

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Marys Care Needs Progress

• Marys dementia progressed and she now needs 24
  hour residential care.
• She develops behavioural difficulties in
  residential care, and stops eating.

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What contribution does general practice have for
aged residential care?Do you think families
understand the dementia trajectory?Who sets the
care goals?
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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

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Important considerations for a palliative
approach to Dementia Care
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• 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
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MNANutrition Assessment
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Depression, Psychosis and other behavioural
Psychological Sx. (BPSD)
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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

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The Way Forward
Hancock K, Chang E, Johnson A et al (2006)
Alzheimers Care Quarterly 7(1) 4957