A systematic review and meta-analysis of palliative care among patients with advanced dementia found a paucity of quality data. These findings were published in the Cochrane Database of Systematic Reviews.
Investigators from multiple institutions across the United Kingdom searched publication databases through October 2020 for studies of palliative care in the advanced dementia setting.
This review and meta-analysis combined a total of 7 new studies with 2 articles identified in a previous review. The studies were of cluster randomized clinical trial (n=6), individually randomized clinical trial (n=2), and controlled before-and-after (n=1) designs.
The studies compared organization and delivery to usual care (n=6) or advanced care planning to usual care (n=3).
For the comparison of organization and delivery, 1,162 participants were included. There was conflicting evidence for improved symptom management and no evidence for improved quality of life (mean difference [MD], -8.20; 95% CI, -16.13 to -0.27). The investigators did observe very uncertain evidence that the intervention increased the comfort in dying (MD, 1.49; 95% CI, 0.34-2.64; I2, 62%), a small effect on advance care planning discussions (RR, 1.08; 95% CI, 1.00-1.18), and little evidence of an effect on documentation of advance directives (RR, 1.46; 95% CI, 0.50-4.25; I2, 52%).
The advanced care planning studies comprised 960 participants. There was no effect on symptom management (MD, -1.80; 95% CI, -6.49 to 2.89) and no effect on decisional conflict (MD, -0.30; 95% CI, -0.63 to 0.03). Advanced care planning was found to improve documentation of advance directives (RR, 1.23; 95% CI, 1.07-1.41; I2, 9%), to have an effect on goals of care discussion (RR, 1.33; 95% CI, 1.11-1.59; I2, 0%), concordance with goals of care (RR, 1.39; 95% CI, 1.08-1.79), and on advance care planning (RR, 1.04; 95% CI, 0.87-1.24).
This review was limited by the overall paucity of data. However, the study authors did note that since their last review in 2016, 6 new studies had been conducted.
Despite the availability of more data, there remained scant evidence to support a particular strategy for providing palliative care among the population of patients with advanced dementia. Additional study is needed such that best practices may be formulated on scientific evidence.
Walsh SC, Murphy E, Devane D, et al. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev. Published online September 28, 2021. doi:10.1002/14651858.CD011513.pub3