The Palliative Approach of Advanced Care Planning for Patients with Dementia

As dementia becomes more prevalent within the older adult population, care that aims to provide comfort or quality of life, as in palliative care, may be a more appropriate option than curative care. A primary characteristic of quality of palliative care is advanced care planning (ACP). It is also a key component for nursing home patients with dementia. ACP is an anticipatory decision-making strategy for patients, family, and professional caregivers that helps to prioritize care goals and future care that is perceived appropriate when considering the patient’s preferences. It differs from traditional care planning in that plans are made in anticipation of future debilitation in a person’s condition.

Due to the fact that dementia is not easy to foresee, deciding when the time is appropriate to begin planning palliative care is a challenge. ACP may give the opportunity for patients and their families to have more time to work out the complex emotional and ethical decisions and could help families of nursing home patients prepare for the last days of their loved one.

ACP is a multifaceted process, but the strategies of physicians involved form the context and other factors, such as the condition of the patient and family issues, potentially changing the content and timing of ACP. Although decisions that are required immediately for survival (hospitalization and resuscitations) are made in advance, a “wait and see” style that is both proactive and responsive is used for palliative care. Consideration of preferences, discussion of care goals and other possible treatments are also involved in ACP.