Comprehensive care in advanced dementia

Dementia is a major public health challenge in relation to population aging, being one of the main causes of disability and dependence.

Worldwide, according to WHO data, in 2015 Alzheimer's disease and other dementias affected 47 million people, and it is estimated that it could double in the next 20 years.

In Spain, it affects 4% of people over 65 years of age and 20% of those over 80 years of age, according to data from the INE (National Statistics Institute), affecting some 700,000 people. In Gerontological Centers it is one of the main causes of institutionalization, according to data obtained from the document "envejecimiento en red" prepared by the CSIC in Spain there are 5,390 Residential Centers that serve 351,548 people, so it represents about 245,000 people, estimating a prevalence of 60% of affected residents.

Dementia, as a neurodegenerative disease, has a progressive course and it is important to identify the advanced stages of the disease to adapt the different treatments and plan the different decision making with caregivers to achieve maximum welfare and proportionality in the intensity of interventions. People without dementia currently die in hospitals, while people with dementia will often die in gerontological centers, so it is of great importance an adequate training of caregivers and families.

Care focused on the disease usually leads to referrals to hospitals in end-of-life situations, with increased risk of using artificial nutrition, intensive treatments, increased costs, decreased family satisfaction and underutilization of palliative resources. A different approach with a person-centered model of care, seeking maximum well-being and comfort, with adequate support and information for the family, is possible through advanced care planning, assessing the current needs of the person and taking into account their values and preferences.

In a series of videos, comprehensive care for people with advanced dementia is presented from different points of view.

1.  The context: 

• Dementia and life expectancy. Enrique Arriola

2.  On assessment and care planning.

• Structured care planning in advanced dementia: CASCADE methodology. Strategic aspects. Javier Alaba
• Comprehensive Geriatric Assessment: from a critical perspective, contribution in advanced chronic disease. Fermín García.

3. On interventions.

• Rationality criteria in the pharmacology of advanced dementia. Dialectics between proportionality of care and futility. Alex Ferro.
• Problems with feeding and hydration in severe dementia Lourdes Rexach.

4. On rights.

• Advance directives. Susana Montesinos
• Quality of life in dementia. Alvaro García