The interface between palliative care and dementia

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This article was exclusively written for The European Sting by Ms. Danielle Correia Furtado and Fernanda Clara da Silva are both second year medical students at Universidade do Estado do Rio Grande do Norte (UERN) in Mossoró, Brazil. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Dementia consists in a group of neurofunctional symptoms that affect an individual’s daily activities, including memory loss from recent or past activities, speech and comprehension difficulties, personality change and mood. The most well-known degenerative chronic disease is Alzheimer’s disease, progressively incapacitating and without cure, which occurs mainly in advancing age, being prevalent among the elderly. According to the Alzheimer Brazil Institute (IAB), there are more than 45 million people living with dementias in the world and that number will double every 20 years.

Thus, people who have some type of dementia, need guidance and care, which vary according to the evolution of the disease. In early stages, sudden forgetfulness, the need to supervise day-to-day activities and mental confusion may occur. In these cases, treatments may even improve the condition, but as they are neurodegenerative diseases without a cure, patients will gradually evolve with worsening symptoms.

So, with the evolution of the disease, the most serious forms can reach these individuals and are very limiting. Functional dependence and cognitive impairment are already severe in these cases and the patient may have difficulties performing basic functions such as walking, talking or eating and even urinary incontinence. Within this scenario, palliative care is a form of intervention that helps in these more severe phases of the clinical condition, which promotes individuality in the care and humanization of that debilitated patient. This attention from a patient-focused team provides dignified and comfortable conditions, not only at the end of that person’s life, but throughout the progression of dementia, providing the best possible quality of life. According to the World Health Organization, palliative care is “assistance promoted by a multidisciplinary team, which aims to improve the quality of life of patients and their families, in the face of a disease that threatens life, through the prevention and relief of suffering, early identification, impeccable evaluation and treatment of pain and other physical, social, psychological and spiritual symptoms ”.

Based on this, it is important that palliative care is present since the diagnosis of dementia, in order to guide and assist the family and bring the maximum possible well-being to the patient, minimizing pain and psychological suffering. Thus, it is possible to offer a comfortable life to that person, as his illness worsens until the time of his death. For this to happen, it is important not only that the family is open to discussing this intervention, but that health teams, such as the neurologist, can promote conversations on the subject, assessing the risks and benefits and also the ethical issues, respecting patient autonomy and also offer relief from suffering, whether psychic or physical.

References

ARAUJO et al. Cuidados Paliativos aos Pacientes Terminais Portadores de Alzheimer: Um Olhar Diferenciado do Enfermeiro. REVISTA SAÚDE – UNG-SER, v. 10, n. 1, p. 5-10. Jun 2016. Disponível em: http://revistas.ung.br/index.php/saude/article/view/2647/2000

MURPHY et al. Palliative care interventions in advanced dementia. Cochrane Database of Systematic Reviews. Dez 2016. Disponível em: doi: 10.1002/14651858.CD011513.pub2

GIL, Gislaine; Di Tommaso, Ana Beatriz. Cuidados paliativos no paciente com demência avançada: o que precisamos saber?. Sociedade Brasileira de Geriatria e Gerontologia. 2018. Disponível em: http://www.sbgg-sp.com.br/cuidados-paliativos-no-paciente-com-demencia-avancada-o-que-precisamos-saber/

About the author

Danielle Correia Furtado and Fernanda Clara da Silva are both second year medical students at Universidade do Estado do Rio Grande do Norte (UERN) in Mossoró, Brazil. They are member of the International Federation of Medical Student’s Associations (IFMSA). Both believe in a world in which education and love is capable of changing the world.

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