Care at the end of life in patients with advanced dementia institutionalized

摘要

Objective : To develop a plan of attention to the terminality in patients with advanced dementia, planning the care through symptomatic control, making decisions with the main caregiver and performing a psychological and spiritual support. Method : Descriptive study of period in the Txara 1 Center of San Sebastian from January 2014 to December 2017, identifying those residents with advanced dementia (GDS 7 and decline syndrome, understood as the presence of total functional dependency and malnutrition). The degree of symptom control (SM-EOLD) is collected quarterly using the PAINAD-Sp scale for pain assessment. At the time of agony, the degree of comfort is determined daily using the scale (CAD-EOLD), establishing with the main caregiver makes decisions based on the palliative care objectives and recording the level of intervention in the electronic medical record. After the death, a satisfaction survey was carried out with the main caregiver (SWC-EOLD) and contact was established with the pastoral for spiritual support. Results : 126 residents with an average age of 87 years are analyzed, 79% are women, and 44% dementia is degenerative. The median of medications is 4.61 and spiritual support is made through the anointing of patients at 70%. In the control of symptoms the pain is evidenced in 8% at least weekly, with a PAINAD-Sp 3 in 20% of the cases, the presence of depression in 4%. In the degree of comfort in situations of agony, the evolution of 64 deaths is recorded (51% of the sample), where the presence of dysphagia is seen in 80%, with the variables of serenity or calm in more than 80 % of the sample. The main cause of death is due to infection of the lower respiratory tract, 93% of the location is in the center itself, with an average of 2.8 incidents, of which 49% are due to dyspnea. Regarding the use of health resources during the last 6 months of life, 12% are referred to the emergency department and 23% require hospital admissions. From the satisfaction survey to the caregivers it is answered by 48%, the overall rating being good at 46% and very good at 54%. Conclusions : The identification of patients with criteria of terminality allows structuring a plan of care in the center, knowing the symptomatic needs, the degree of comfort and reaching decisions regarding the proportionality of care with the family. Care resources must be properly integrated in order to respond to emergency situations and be able to comply with the decisions adopted.