3. Mary’s Care Needs Progress Mary’s dementia progressed and she now needs 24 hour residential care. She develops behavioural difficulties in residential care, and stops eating.

4. What contribution does general practice have for aged residential care? Do you think families understand the dementia trajectory? Who sets the care goals?

5. Dementia Care Planning  Communication and collaboration with loved ones is the most important  Advanced Dementia Clinical Course (Mitchell, et al., 2009)  Pneumonia, febrile episodes, and eating problems are frequent complications in patients with advanced dementia,  complications are associated with high 6-month mortality rates  Residents with Families that understood likely complications had less hospitalisations

6. Important considerations for a palliative approach to Dementia Care Weight Loss Pain Shortness of Breath Agitation Dysphagia and aspiration Recurrent Infections, esp. pneumonia

7. Quality of life, comfort and wellbeing are the right of every elderly person facing the last years of life. Life limiting disease can cause discomfort and pain The right of every individual to determine their care and treatment Australian Palliative Care Approach Guidelines http://www.health.gov.au/internet/wcms/publishing.nsf/Content/palliativecare-pubs-workf-guide.htm

8. MNA Nutrition Assessment

9. Depression, Psychosis and other behavioural & Psychological Sx. (BPSD) DepressionPsychosisAgitation

10. Antipsychotics Only use for:  severe agitation, psychomotor behaviour, hallucinations, paranoia, behavioural problems associated with dementia Do not prescribe for:  wandering, pacing or on PRN basis Increases mortality

11. The Way Forward The development of advanced dementia evidence- based guidelines Advance care planning in the early stages of dementia More research into palliative care needs of people with advanced dementia A palliative care approach Consultation with specialists and multidisciplinary teams at end of life Continuity of care and collaboration between healthcare professionals and families is critical Hancock K, Chang E, Johnson A et al (2006) Alzheimer’s Care Quarterly 7(1): 49–57