Journal Article

Characteristics of people diagnosed with dementia vs lung cancer and cardiovascular disease at commencement of community palliative care: a population–based study

Dai, Yunyun, Tan, Minghui, Ding, Jinfeng, Qin, Xinwen Simon, Wang, Guiyun, Zanjani, Maya Ebrahimi, Cook, Angus, Johnson, Claire E.

2024

Overview

Background Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients’ functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Activities of daily living / Aged / Aged, 80 and over / Australia / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - therapy / Care and treatment / Caregivers / Clinical outcomes / Community Health Services - methods / Community Palliative Care / Complications and side effects / Dementia / Dementia - therapy / Diagnosis / Elder care / Female / Function / Home care / Humans / Lung cancer / Lung Neoplasms - complications / Lung Neoplasms - therapy / Male / Medical personnel / Medicine / Medicine & Public Health / Middle Aged / Pain Medicine / Palliative care / Palliative Care - methods / Palliative Care - standards / Palliative Care - statistics & numerical data / Palliative Medicine / Patients / Population-based studies / Prevention / Quality of Life Research / Risk factors / Supervision / Symptom