Keywords
1. Home hospice care dementia
2. Palliative care for dementia
3. Dementia end-of-life care
4. Advanced dementia treatment
5. Caregiver support dementia
Amidst the rising prevalence of dementia worldwide, a groundbreaking study published in the “Israel Journal of Health Policy Research” has offered a beacon of hope for individuals suffering from advanced stages of the disease, as well as their caregivers. The study, documented in the DOI 10.1186/s13584-019-0304-x, highlights the significant benefits of introducing home hospice care for older people with advanced dementia and provides robust evidence supporting the efficacy of such programs.
Introduction
Dementia is a terminal illness that severely impairs cognitive function, affecting millions of elderly patients globally. Traditional models of care often focus on prolonging life without sufficiently addressing quality of life and symptom management (Livingston et al., 2017). The innovative study in question, carried out as a quality improvement pilot project by Sternberg et al. (2020), sought to transform the paradigm by extending comprehensive home hospice care to this population.
The Home Hospice Pilot Project
The project enrolled twenty older adults with advanced dementia from the Maccabi Healthcare Services homecare program in Israel. Over 6-7 months, or until death, participants received home hospice care from a multidisciplinary team available around the clock. Clinical and health services outcomes were meticulously recorded, revealing a promising alternative approach to dementia care.
Clinical Outcomes and Health Services Impacts
The results, based on 112 months of care with an average of 5.6 months per participant, were profound. An increase in symptom management scores from 33.8 upon admission to 38.3 upon discharge was observed, alongside escalated satisfaction with care from 27.5 to 35.3. Perhaps most strikingly, caregiver burden on the Zarit Burden index plummeted from 12.1 to a mere 1.4, revealing significant emotional relief for those caring for patients (Sternberg et al., 2020).
The program saw a substantial reduction in hospitalizations, with only five occurring during the pilot versus an anticipated 33, showcasing the capability of home hospice to manage symptoms effectively within the home environment. Medication use also witnessed a decline, with an average of 2.1 medications discontinued per participant, indicating a move away from unnecessary polypharmacy towards targeted, symptom-specific treatments.
Family Members’ Perspectives
The study offered valuable insights from the families of individuals with advanced dementia. Many reported that the professionalism and constant availability of care staff delivered unparalleled peace of mind. This satisfaction extended beyond mere gratitude for symptoms management to encompass appreciation for the compassionate communication and support offered by the hospice team.
Challenges and Considerations
Despite its successes, the project acknowledges several hurdles, including the difficulty of prognosticating six-month mortality in advanced dementia patients – a critical factor in hospice eligibility (Mitchell et al., 2009). The article also encourages future research to devise better predictive tools to identify those who would benefit most from early home hospice intervention (Mitchell et al., 2010).
Implications on Policy and Practice
Given the evidence presented, there is an increasing imperative for health policy makers to incorporate home hospice into standard care for elderly patients with terminal dementia. Such integration could potentially alleviate the immense pressure on hospital systems and improve the end-of-life journey for the dementia population.
Funding Acknowledgment and Competing Interests
The research was supported by the Israel Ministry of Health, Division of Geriatrics. Critics of the study might raise the potential for biased results due to funding sources or affiliations; however, the authors have declared that they have no competing interests, thus underscoring the integrity and objectivity of the findings.
The Multidimensional Advantage of Home Hospice
The study elucidates the multifaceted benefits of home hospice care for advanced dementia, showing improvements not only in the clinical and physical domain but also in the psychosocial aspects of patient and caregiver well-being. It demonstrates that, with the right support, terminal dementia can be managed with dignity and compassion, reinforcing the tenets of holistic and patient-centered care (Van der Steen, 2010).
Conclusion
Broad adoption of home hospice for advanced dementia could signify a monumental shift in caring for one of the most vulnerable segments of the elderly population. The study by Sternberg and colleagues serves as an empirical foundation for a wholesale reform in dementia care, offering a model that better aligns with the humane and ethical principles of palliative medicine (Shega et al., 2008). It contributes to the reimagining of an end-of-life care framework that not only prioritizes life quality but also provides crucial support for families navigating the final chapters of their loved ones’ lives.
References
1. Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., Cooper, C., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Larson, E. B., Ritchie, K., Rockwood, K., Sampson, E. L., Samus, Q., Schneider, L. S., Selbæk, G., Teri, L., & Mukadam, N. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734. DOI: 10.1016/S0140-6736(17)31363-6.
2. Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., … & Hamel, M. B. (2009). The clinical course of advanced dementia. New England Journal of Medicine, 361(16), 1529-1538. DOI: 10.1056/NEJMoa0902234.
3. Sternberg, S. A., Sabar, R., Katz, G., Segal, R., Fux-Zach, L., Grofman, V., … & Bentur, N. (2020). Home hospice for older people with advanced dementia: a pilot project. Israel journal of health policy research, 8(1), 42. DOI: 10.1186/s13584-019-0304-x.
4. Van der Steen, J. T. (2010). Dying with dementia: What we know after more than a decade of research. Journal of Alzheimer’s Disease, 22(1), 37-55. DOI: 10.3233/JAD-2010-100744.
5. Shega, J. W., Hougham, G. W., Stocking, C. B., Cox-Hayley, D., & Sachs, G. A. (2008). Patients dying with dementia: Experience at the end of life and impact of hospice care. Journal of Pain and Symptom Management, 35(5), 499-507. DOI: 10.1016/j.jpainsymman.2007.06.011.
