Integration of a Palliative Approach in the Care of Older Adults with Dementia in Primary Care Settings: A Scoping Review
Open accessAbstract
Abstract A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.
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Clinicians identify multiple barriers to initiating ACP conversations in persons living with dementia, including unpredictable illness trajectory, uncertainty about the right time to commence ACP, lack of time, resources, and knowledge, discomfort with ACP discussions, and difficulty determining the decision-making capacity of the person living with dementia.
“Numerous factors have been identified by clinicians as barriers to initiating ACP conversations in PLwD including unpredictable illness trajectory; uncertainty about the right time to commence the ACP process [10–12]; lack of time, resources, and knowledge; discomfort with ACP discussions [8, 13]; and difficulty in determining the decision-making capacity of the PLwD [14].”
From Acceptability of the voice your values, an advance care planning intervention in persons living with mild dementia using videoconferencing technology (2022) · cites this paper as [10]
The Discussion and ACP sections identify an unpredictable dementia trajectory, uncertainty about when to discuss ACP, lack of training, and concern that discussions may cause distress. The review also reports lack of time and apprehension about patients’ decision-making capacity. It discusses limited support and funding, but does not clearly identify a lack of resources as a barrier to initiating ACP conversations specifically; page numbers are unavailable in our copy. (LLM, conf=0.83)
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Cited by
Sorted by citations
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- Authors
- Vellani, S., Puts, M., Iaboni, A., Degan, C., & McGilton, K. S.
- Affiliations
- University Health Network (CA)
- University of Toronto (CA)
- Corresponding author
- Vellani, Shirin
- Venue
- Canadian Journal on Aging / La Revue canadienne du vieillissement
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-11-08
- Volume
- 41
- Issue
- 3
- Pages
- 404-420
- ISSN
- 0714-9808 (ISSN-L)
- 1710-1107
- OpenAlex
- W3212891572
- Cited by
- 17
- References
- 64
- Citations by year
- 2026: 2 · 2024: 8 · 2023: 2 · 2022: 4 · 2021: 1
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Canadian Journal on Aging / La Revue canadienne du vieillissement (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- palliative care, dementia, older adults, primary care, outcome prediction, interdisciplinary collaboration, intersectoral collaboration
- MeSH terms
- Aged, Dementia, Humans, Palliative Care, Primary Health Care
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