The response letter by Nash et al to our recent article
1
raises the concern that the palliative care “lens” was missing from the patient vignette.
We would note that the case described a patient who has moderate dementia and thus,
we would not consider this person to have “advanced” illness. We agree that more attention
is needed to understand when the person living with dementia is approaching end of
life, as this can be difficult to ascertain in the course of an illness that can last
up to a decade. However, the describe, investigate, evaluate, and create (DICE) approach
2
is entirely compatible with the palliative care approach “through the prevention
and relief of suffering by means of early identification and impeccable assessment
and treatment of pain and other problems, physical, psychosocial, and spiritual.”
3
Delirium is definitely one of the concerns addressed in the DICE approach.World Health Organization
Definition of Palliative Care.
Definition of Palliative Care.
https://www.who.int/cancer/palliative/definition/en/
Date accessed: December 15, 2019
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References
- When less is more, but still not enough: Why focusing on limiting antipsychotics in people with dementia is the wrong policy imperative.J Am Med Dir Assoc. 2019; 20: 1074-1079
- Detroit Expert Panel on Assessment and Management of Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel.J Am Med Dir Assoc. 2014; 62: 762-769
- Definition of Palliative Care.(Available at:)https://www.who.int/cancer/palliative/definition/en/Date accessed: December 15, 2019
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Published online: January 31, 2020
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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