volicer ladislav
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8/14/2019 Volicer Ladislav
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ABSTRACT FORM
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Pain and other symptoms
Palliative care for cancer patients
Palliative care for non cancer
patients
Paediatric palliative care
Palliative care for the elderly
The actors of palliative care
Latest on drugs
Pain
Illness and suffering through
media
Marginalisation and social stigma
at the end of life
Palliative care advocacy projects
Prognosis and diagnosis
communication in
different cultures
Communication between doctor-
patient and patient-
equipe
Religions and cultures versus
suffering, death and
bereavement
Public institution in the world:
palliative care policies
and law
Palliative care: from villages to metropolies
Space, light and gardens for the terminally ill patient
End-of-life ethics
Complementary therapies
Education, training and research
Fund-raising and no-profit
Bereavement support
Volunteering in palliative care
Rehabilitation in palliative care
CARE AND DECISIONS IN END-OF-LIFE DEMENTIA
Authors (max 6, presenting author included): Ladislav Volicer
Advanced dementia is a terminal disease because there are currently no treatments that wouldcure it or stop its progression. The goals of treatment in advanced dementia are preserving qualityof life, dignity and comfort. Quality of life is preserved by attention to three areas: provision ofmeaningful activities, appropriate management of medical problems and treatment of behavioralsymptoms of dementia. Meaningful activities and comfort measures should be provided even invery severe dementia because Alzheimers disease does not progress into a vegetative state. Themost important comfort measure is prevention and treatment of pain, and avoidance ofinappropriate aggressive medical interventions. Medical interventions that may not beappropriate for individuals with advanced dementia include cardiopulmonary resuscitation(CPR), transfer to an acute care setting, use of antibiotics for treatment of generalized infectionsand use of tube feeding. CPR is rarely successful in advanced dementia and in those who initially
survive results in significant suffering. It is better to treat infections, such as pneumonia, in achronic care setting than to transfer the resident to an acute care hospital because hospitalizationresults in severe discomfort and functional decline. Comfort during generalized infections can bemaintained by the use of analgesics and antipyretics and does not require the use of antibiotics.Tube feeding has no benefits in individuals with advanced dementia and may result in severediscomfort and decreased quality of life. Decisions about use of these interventions should be
based on patients previous wishes if they are known, or on his/her best interest interpreted by aperson who knows the patient the best. Management of behavioral symptoms should start withnon-pharmacological approaches and should recognize the difference between agitation andresistiveness to care.
Session: Palliative care in the elderly
Chair of the session: Dott. Donatella Bartolozzi
Antea Worldwide Palliative Care ConferenceRome, 12-14 November 2008
Ladislav Volicer
mailto:[email protected]:[email protected]