Background Dementia is fatal disease and becomes burden due to increased elderly population. Karunruk Palliative Care Center (KPC) has established a care program for late-stage dementia. Family education on disease trajectory and established advance care plan (ACP), which inform about the preferences on place of care and death and medical treatment. The program provides routine home visit by multidisciplinary palliative care team, 24-hour emergency call and direct admission to palliative unit.
Methods Profiles of 65 patients recruited from October 1, 2020 to September 30, 2022 were: 84.6% were > 80 years, 76.93% were in FAST stage > 7c, and 43.07% retained NG feeding/PEG. Data were analyzed to obtain the concordance between the patients’ preferences and the actual outcomes.
Results Only 7/65 (10.76%) had an ACP before referral. All patients in our program had an ACP. Place of death of 30 patients who died were 43.33% at home, 43.33% at Palliative unit, 10.0% at medical ward, and 3.34% at nursing home.
Concordance of patients’ preferences and the actual outcomes
Place of death Preferences Actual outcomes Concordance (%)
Home 18 13 72.22
Hospital 10 10 100.0
Nursing home 2 1 50.0
Comfort 30 30 100
*Six patients changed place of death to hospital due to COVID-19 infection required admission (2), and care giver burden (4). Overall concordance of place of death was 80% and all patients received comfort care. The mean length of care was 404 days (max 1,794, min 13 days)
Conclusion The patient preferences in our program were well respected. A comprehensive palliative care program is essential to improve outcomes and avoid medical futility in these patients.
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