TY - JOUR
T1 - Referral criteria to specialist palliative care for patients with dementia
T2 - A systematic review
AU - Mo, Li
AU - Geng, Yimin
AU - Chang, Yuchieh Kathryn
AU - Philip, Jennifer
AU - Collins, Anna
AU - Hui, David
N1 - Publisher Copyright:
© 2021 The American Geriatrics Society
PY - 2021/6
Y1 - 2021/6
N2 - Background: Patients with dementia often have significant symptom burden and a progressive course of functional deterioration. Specialist palliative care referral may be helpful, but it is unclear who and when patients should be referred. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with dementia. Methods: We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, Cochrane Library, PubMed, and CINAHL databases for articles from inception to December 3, 2019, related to specialist palliative care referral for dementia. Two investigators independently reviewed the citations for inclusion, extracted the referral criteria, and categorized them thematically. Results: Of the 1788 citations, 59 articles were included in the final sample. We identified 13 categories of referral criteria, including 6 disease-based and 7 needs-based criteria. The most commonly discussed criterion was “dementia stage” (n = 43, 73%), followed by “new diagnosis of dementia” (n = 17, 29%), “medical complications of dementia” (n = 12, 20%), “prognosis” (n = 11, 19%), and “physical symptoms” (n = 11, 19%). Under dementia stage, 37/44 (84%) articles recommended a palliative care referral for advanced dementia. Pneumonia (n = 6, 10%), fall/fracture (n = 4, 7%), and decubitus ulcers (n = 4, 7%) were most commonly discussed complications to trigger a referral. Under prognosis, the time frame for referral varied from <2 years of life expectancy to <6 months. 3 (5%) of articles recommended “surprise question” as a potential trigger. Conclusions: This systematic review highlighted the lack of consensus regarding referral criteria for palliative care in patients with dementia and the need to identify timely triggers to standardize referral.
AB - Background: Patients with dementia often have significant symptom burden and a progressive course of functional deterioration. Specialist palliative care referral may be helpful, but it is unclear who and when patients should be referred. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with dementia. Methods: We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, Cochrane Library, PubMed, and CINAHL databases for articles from inception to December 3, 2019, related to specialist palliative care referral for dementia. Two investigators independently reviewed the citations for inclusion, extracted the referral criteria, and categorized them thematically. Results: Of the 1788 citations, 59 articles were included in the final sample. We identified 13 categories of referral criteria, including 6 disease-based and 7 needs-based criteria. The most commonly discussed criterion was “dementia stage” (n = 43, 73%), followed by “new diagnosis of dementia” (n = 17, 29%), “medical complications of dementia” (n = 12, 20%), “prognosis” (n = 11, 19%), and “physical symptoms” (n = 11, 19%). Under dementia stage, 37/44 (84%) articles recommended a palliative care referral for advanced dementia. Pneumonia (n = 6, 10%), fall/fracture (n = 4, 7%), and decubitus ulcers (n = 4, 7%) were most commonly discussed complications to trigger a referral. Under prognosis, the time frame for referral varied from <2 years of life expectancy to <6 months. 3 (5%) of articles recommended “surprise question” as a potential trigger. Conclusions: This systematic review highlighted the lack of consensus regarding referral criteria for palliative care in patients with dementia and the need to identify timely triggers to standardize referral.
KW - dementia
KW - palliative care
KW - referral and consultation
KW - selection criteria
KW - systematic review
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U2 - 10.1111/jgs.17070
DO - 10.1111/jgs.17070
M3 - Review article
C2 - 33655535
AN - SCOPUS:85101875876
SN - 0002-8614
VL - 69
SP - 1659
EP - 1669
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 6
ER -