Palliative consideration of cutting edge dementia A patient focused methodology.


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Palliative consideration of cutting edge dementia A patient focused methodology ... As of now, patients with dementia don't become acquainted with quality palliative consideration ...
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Palliative consideration of cutting edge dementia A patient focused methodology VJ Periyakoil, MD Director, Palliative Care Fellowship Program Stanford University General Internal Medicine & VA Palo Alto Health Care System Email: periyakoil@stanford.edu

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Main Message Currently, patients with dementia don\'t access quality palliative consideration Access to quality palliative consideration can be encouraged just on the off chance that we take a between disciplinary way to deal with consideration

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Talk Agenda Current condition of palliative look after dementia Key difficulties in giving palliative consideration to dementia patients Prognostication Decision making Advance consideration arrangement Symptom administration Caregiver stress

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Prognostication questions in dementia Patient\'s inquiry: "To what extent do I have before my brain is shot?" Health expert\'s inquiry: " Is s/he qualified for palliative care?" Family\'s inquiry: "To what extent does s/he need to live ?" Caregiver\'s inquiry: " I am totally worn out. How much more would I be able to do this?" Is dementia a terminal sickness? Provided that this is true, when do they begin kicking the bucket?

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Dementia hospice qualification Stage 7 or past as per the FAST scale Unable to ambulate without help Unable to dress without help Unable to bathe without help Urinary or fecal incontinence, irregular or steady No important verbal correspondence, cliché states just, or capacity to talk constrained to six or less coherent words Plus one of the accompanying inside the previous 12 months: Aspiration pneumonia Pyelonephritis or other upper UTI Septicemia Multiple stage 3 or 4 decubitus ulcers Fever that repeats after anti-toxin treatment Inability to keep up adequate liquid and calorie consumption, with 10 percent weight reduction amid the past six months or serum egg whites level under 2.5 g for each dL (25 g for every L) Schonwetter RS, Han B, Small BJ, Martin B, Tope K, Haley WE. Indicators of six-month survival among patients with dementia: an assessment of hospice Medicare rules. Am J Hosp Palliat Care 2003;20:105-13.

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Decision settling on in dementia Hierarchy of basic leadership Pt with limit Advance order Health care intermediary Living will Substituted judgment Best advantages Competence v. limit Special circumstances

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Special circumstances Case 1: Incapacitated pt with no intermediary and obscure inclinations Case 2: Chronically rationally sick pts with no limit Case 3: Chronically rationally sick pts with fluctuating limit

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Intact basic leadership preceding demise in the elderly Lentzer HR et al " The personal satisfaction in the prior year passing". Am J Public Health 82: 1093-1098, 1992

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Interface between palliative consideration and dementia Clarity of basic leadership Soft balls ( generally): Advanced dementia with cutting edge other terminal sickness Early dementia with early phases of other perpetual ailment Hard balls Moderate dementia with other terminal ailment Dementia, terminal ailment, contamination and insanity Dementia and PTSD or despondency Dementia and recreational ETOH/drug utilize The choices themselves are never simple.

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Advance consideration arranging Shades of Gray Possible levels of consideration: Full court press Hospitalize with DNR Hospitalize for reversible sickness Do not hospitalize (DNH): treat to the degree conceivable DNH with solace care

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Heroic life drawing out measures CPR "Whopper no veggie*" Artificial sustenance Artificial hydration Antibiotics What are the objectives of consideration? * James Hallenbeck, individual correspondence

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Tube encourage or not tube sustain? That is the issue The realities: Effect on life range is an open inquiry Increases languishing Need over better pt/family training Discussing advantages and weights of treatment Use impartial dialect Separate actualities from your supposition Please offer your sentiment Make stipends for extraordinary circumstances.

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Symptoms Bio Pain Non-torment manifestations Psychological issues Social issues Spiritual issues Presentation of these indications is skewed Palliative consideration side effects and intellectual disability

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What does biting the dust resemble? Decrease in useful status Lack of longing to eat or drink Withdrawn Sleep-wake state Mottling of appendages Jaw development Death clatter Co-horrible side effects

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??? Unpaid Overworked accessible if the need arises every minute of every day Sleep denied No social life Poor emotionally supportive network

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Notes Questions/input: Please contact VJ Periyakoil periyakoil@stanford.edu hospice@va.gov ___________________________________

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