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Palliative care in dementia: issues and evidence

Julian Hughes is a consultant in old age psychiatry in Northumbria Healthcare NHS Trust (Ash Court, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK. Email: j.c.hughes{at}ncl.ac.uk) and an honorary clinical senior lecturer at the Institute for Ageing and Health, Newcastle University. His interests are in the philosophy of ageing and psychiatric ethics. David Jolley is honorary reader in old age psychiatry, Manchester University, and part-time consultant psychiatrist at the Pennine Care NHS Trust. A pioneer of services for older people, his interest spans the field of clinical psychiatry of late life. Alice Jordan is a specialist registrar in palliative medicine. She currently holds a research and teaching fellowship to undertake work towards an MD thesis entitled ‘The assessment of good practice in pain management in advanced dementia: a pilot study’. Elizabeth Sampson is an old age psychiatrist and MRC Research Fellow, based at University College, London. Her principle research interests are in improving end-of-life care for people with dementia, particularly those on acute hospital wards, delirium and liaison psychiatry for older people.

Palliative care is an approach that stands well with the aims of person-centred dementia care. There is no doubt that the standards of care for many people with advanced dementia are poor. There is a lack of good-quality evidence, however, to support any particular approach for palliative care in dementia. Still, there are a number of areas in relation to caring for people with severe dementia where a palliative approach might be beneficial. In general, the relevant decisions have to be made on an individual basis but within a palliative framework. Advance care planning is likely to be crucial in encouraging this process. There is certainly a moral imperative behind the idea that care at the end of life for people with dementia should be improved.