Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study

doi:10.1177/0269216317751334

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Title:	Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study
Authors:	Chen, Ping-Jen Liang, Fu-Wen Ho, Chung-Han Cheng, Shao-Yi Chen, Yi-Chen Chen, Yu-Han Chen, Yueh-Chun
Contributors:	Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Family Med Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Div Geriatr & Gerontol Chi Mei Med Ctr, Palliat Care Ctr Natl Cheng Kung Univ, Coll Med, NCKU Res Ctr Hlth Data Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Hosp & Hlth Care Adm Natl Taiwan Univ, Dept Family Med, Coll Med Natl Taiwan Univ, Univ Hosp Chi Mei Med Ctr, Dept Family Med Chi Mei Med Ctr, Dept Nursing
Keywords:	Cross-cultural comparison dementia life-support care national health programmes neoplasms palliative care
Date:	2018-03
Issue Date:	2019-11-15 15:47:46 (UTC+8)
Publisher:	SAGE PUBLICATIONS LTD
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.
???metadata.dc.relation.uri???:	http://dx.doi.org/10.1177/0269216317751334
Relation:	Journal of Cosmetic Science, v.32, n.3, SI, pp.622-630
Appears in Collections:	[Dept. of Pharmacy] Periodical Articles

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