Clinical Question

Are palliative care interventions effective in advanced dementia?

Evidence-Based Answer

Advance care planning interventions for people with advanced dementia likely increase the documentation of advance directives (relative risk [RR] = 1.23; 95% CI, 1.07 to 1.41) and the number of discussions about goals of care with family decision-makers (RR = 1.33; 95% CI, 1.11 to 1.59). These may slightly increase concordance with goals of care (RR = 1.39; 95% CI, 1.08 to 1.79). However, there is no effect on perceived symptom management as rated by family and nursing staff.¹ (Strength of Recommendation: C, limited-quality, disease-oriented evidence.)

Practice Pointers

Dementia is a debilitating, prevalent, and costly condition affecting more than 55 million people worldwide.^2,3 Despite dementia being a leading cause of death in the United States, palliative care interventions have not been widely utilized in the care of people affected by advanced dementia. Palliative care is an inclusive approach that focuses on the patient’s quality of life as well as the caregivers who face problems associated with life-threatening illness.⁴ The objective of this review is to assess the effectiveness of palliative care interventions in advanced dementia and to update a previous Cochrane review from 2016.⁵