Question

Aged residents living with dementia, palliative care and pain assessments?

Answer 1

Dementia is a life limiting illness charecterized by widespread physical,behavioural and cognitive impairment resulting in severe disabilities that persist until death.The global prevalence of dementia is projected to increase to almost 132 million by 2050.The high demand for dementia care,the individual's prefernce to stay at home for as long as possible combined with limited supply and rising cost of institutional long tem care services highlight an urgent need to find effective strategies to improve home based care for people with dementia,including those with advanced dementia requiring nd of life care.

support of people living with dementia and their families has influenced by a range of initiatives designed to put the person first.The most inflluential is the concept of person centred care,first conceived by Tom Kitwood.In his model, a person has absolute values and worthy of respect regardless of disability.He uses the acronym VIPS,to identify the people with dementia and their families should be Valued;people with dementia must be treated as Individuals;the Perspective of the person with dementia must inform our understanding;and the person's Social enviornment must be attended to.Palliative care is for any people of any age who have a serious illness that cannot be cured.Dying is a normal process,with palliative care offering a support system to help people to live their life asfully and comfortably as possible until death,and to help families cope during these llness and in their bravement.The term 'Palliative careapproach refers to care provided by any health care proffesional that adapt palliative care knowledge and expertise to meet the needs of eople with chronic life limiting conditions.There are some specific terms like 'end of life care' and 'specialist palliative care' which needs clarification.End of life is the period when the person is living with,and impaired by fatal condition,even if the trajectory is unknown.Specialist palliative care is a subset of palliative care provided by clinicians who have advanced training in palliative care.There are number of programs by government to support people with dementia at home.The homecare packages program provides patient with higher intensity,ongoing services as an ndividualized budget that the patient controls.

Pain is a common symptom in dementia with prevalence rate reported in some studies to be around 36-50% with the incidence and severity of pain is increasing with advancing disease.pain is expressed verbally,through body language,emotional responses behaviours and physiological changes.Some commonly used scales inpain assesment includes,

Assesment of Discomfort in dementia protocol(ADD)

Abbey Pain Scale
Discomfort in Dementia of the Alzheimer's type

pain assesment in advanced dementia

Face,legs,activity,cry, cosolable scale

pain assesment checklist for seniors with limited ability to communicate