Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study
Journal
Palliative Medicine
Journal Volume
32
Journal Issue
3
Pages
622-630
Date Issued
2018
Author(s)
Abstract
Background: The association between palliative care and life-sustaining treatments for patients with dementia is unclear in Asian countries. Aim: To analyse the use of palliative care and its association with aggressive treatments based on Taiwanese national data. Design: A matched cohort study was conducted. The association between intervention and outcome was evaluated using conditional logistic regression analyses. Setting/participants: The source population comprised 239,633 patients with dementia diagnosed between 2002 and 2013. We selected patients who received palliative care between 2009 and 2013 (the treatment cohort; N = 1996) and assembled a comparative cohort (N = 3992) through 1:2 matching for confounding factors. Results: After 2009, palliative care was provided to 3928 (1.64%) patients of the dementia population. The odds ratio for undergoing life-sustaining treatments in the treatment cohort versus the comparative cohort was <1 for most treatments (e.g. 0.41 for mechanical ventilation (95% confidence interval: 0.35–0.48)). The odds ratio was >1 for some treatments (e.g. 1.73 for tube feeding (95% confidence interval: 1.54–1.95)). Palliative care was more consistently associated with fewer life-sustaining treatments for those with cancer. Conclusions: Palliative care is related to reduced life-sustaining treatments for patients with dementia. However, except in the case of tube feeding, which tended to be provided alongside palliative care regardless of cancer status, having cancer possibly had itself a protective effect against the use of life-sustaining treatments. Modifying the eligibility criteria for palliative care in dementia, improving awareness on the terminal nature of dementia and facilitating advance planning for dementia patients may be priorities for health policies. ? 2018, ? The Author(s) 2018.
Subjects
Cross-cultural comparison; dementia; life-support care; national health programmes; neoplasms; palliative care
SDGs
Other Subjects
aged; Article; artificial ventilation; blood transfusion; cancer diagnosis; Charlson Comorbidity Index; cohort analysis; controlled study; defibrillation; dementia; disease association; endotracheal intubation; enteric feeding; female; hemodialysis; human; ICD-9-CM; length of stay; life sustaining treatment; major clinical study; male; mortality; outcome assessment; palliative therapy; positive end expiratory pressure; resuscitation; tracheostomy; comparative study; dementia; long term care; middle aged; odds ratio; palliative nursing; palliative therapy; procedures; psychology; quality of life; statistics and numerical data; Taiwan; terminal care; very elderly; Aged; Aged, 80 and over; Cohort Studies; Dementia; Female; Hospice and Palliative Care Nursing; Humans; Life Support Care; Male; Middle Aged; Odds Ratio; Palliative Care; Quality of Life; Taiwan; Terminal Care
Publisher
SAGE Publications Ltd
Type
journal article