A Preliminary Study on Patients with Dementia’s End-of-life Caring Pattern

• Main Authors: HUANG,LI-WEN, 黃莉雯
• Other Authors: TSAI,PEI-JEN
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/36604482912315761180

碩士 === 國立暨南國際大學 === 社會政策與社會工作學系 === 104 === Dementia is common in elderly and is a progressive cognitive impairment, which cannot be completely prevented and cured. The number of people with dementia is increasing at a rate of one person every four seconds. With the future trend of aging society and low birth rate, the condition is a major issue for government policy around the world. At their terminal stage of dementia, patients generally lose all expressive and cognitive abilities, as well as both the intrinsic and the extrinsic autonomy. The lack of discussion on medical care program for this population may result in disastrous outcome for the society as a whole. The hospice palliative care is designed as a privilege for patients at end-of-life. However, the disease properties of these patients of dementia vary greatly from the originally intended population with caner, as limited by the service provided to care patients in dementia who obviously have totally different or partial cognitive function, they will not exactly be satisfied by the ideal of tranquility and its five circles of care. It certainly raises the question of definition and needs of a patient at end-of-life of dementia. Objectives: (1)Needs of a patient at the end-of-life of dementia. (2) The best time for intervention of palliative care for patients at palliative of dementia. (3)Strategy of palliative care program for patient at palliative of dementia. The study was a qualitative research. Through in-depth interview of 9 family relatives of dementia patients, the selection criteria would include family members who participated throughout the entire course of disease since diagnosis, even if they had entrusted patients to other caretakers or institutions, as they played key role in decision-making and continued to involve in patient's change of condition. These family relatives were in control of the entire medical care of patients. The diagnosis condition and presentation of dementia cases in the study were not different from references. Family members generally tended to patient's physiological and social condition and rarely extended to observe and care after internal needs in psychological or even spiritual aspect. Especially, many patients exhibited multiple signs of deterioration and some might be faster or slower than others. Most patients showed fair cognition function and thus, they were generally excluded from the current standard of palliative care program (CDR=5). Result showed the followings: (1) long and irreversible course of disease; (2) classification as long-term chronic disease but with fluctuating disease condition; (3) generally old age and weaker in health, leading to late discovery of disease; (4) lack of seeking medical assistance by caretaker and family member, as unrealistic practice of providing service based on term of disease. Due to these reasons, dementia patients should have characteristic definition of end-of-life, "a continuously aggravating condition/disease that eventually leads to death", which would classify the disease as a type of medical end-of-life condition. By analyzing interview content, researchers believed that a family of dementia patient would desperately need a long-term palliative care program, with focus on: (1) Advanced Care Planning (ACP); (2) Aged Care Community; (3) Palliative Care in Home; (4) Institutional Care, which could completely cover a continuous care for a patient.