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Feature Article

Death, dying and dementia – a pivotal role for the GP

SUE MARKHAM, TIFFANY JESSOP, Carmelle Peisah

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Abstract

Identifying patients nearing the end of life is important so that patients, families and their GPs can prepare and work together to provide quality care and comfort to the patient according to their wishes and preferences.

Key Points

  • Dementia is a chronic, neurodegenerative, terminal illness with widely variable survival times of three to 12 years that make predicting death difficult.
  • Throughout the course of dementia, the goals of care should be to improve quality of life, maintain as much function as possible and maximise the person’s comfort.
  • A palliative care approach for patients with dementia should be implemented in a timely and personalised way, not in the last few days of life but in the last 12 months or even earlier.
  • The Gold Standard Framework is aimed at helping to identify people in the last year of life, and to assess their needs, symptoms and preferences and plan care on that basis.
  • An advance care plan needs to be distinguished from a legally binding advance care directive made by the patient; in many ways it can be more helpful because it is dynamic in accordance with the person’s needs.
  • The key to managing behaviour change in patients with dementia is to work out the underpinning biological, psychological or social/environmental cause(s), including unmet needs.
  • Effective pain management can not only provide relief from pain, but also relief from agitation in people with dementia.

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© PHOTOLUMINATE LLC/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© PHOTOLUMINATE LLC/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY