Ping-Jen Chen1,2,3, Fu-Wen Liang4, Chung-Han Ho5,6, Shao-Yi Cheng7, Yi-Chen Chen5, Yu-Han Chen8, Yueh-Chun Chen2,9. 1. 1 Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 2. 2 Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 3. 3 Palliative Care Center, Chi Mei Medical Center, Tainan, Taiwan. 4. 4 The NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan. 5. 5 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan. 6. 6 Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan, Taiwan. 7. 7 Department of Family Medicine, College of Medicine and University Hospital, National Taiwan University, Taipei, Taiwan. 8. 8 Department of Family Medicine, Chi Mei Medical Center, Liouying, Taiwan. 9. 9 Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan.
Abstract
BACKGROUND: The association between palliative care and life-sustaining treatments for patients with dementia is unclear in Asian countries. AIM: To analyse the use of palliative care and its association with aggressive treatments based on Taiwanese national data. DESIGN: A matched cohort study was conducted. The association between intervention and outcome was evaluated using conditional logistic regression analyses. SETTING/PARTICIPANTS: The source population comprised 239,633 patients with dementia diagnosed between 2002 and 2013. We selected patients who received palliative care between 2009 and 2013 (the treatment cohort; N = 1996) and assembled a comparative cohort ( N = 3992) through 1:2 matching for confounding factors. RESULTS: After 2009, palliative care was provided to 3928 (1.64%) patients of the dementia population. The odds ratio for undergoing life-sustaining treatments in the treatment cohort versus the comparative cohort was <1 for most treatments (e.g. 0.41 for mechanical ventilation (95% confidence interval: 0.35-0.48)). The odds ratio was >1 for some treatments (e.g. 1.73 for tube feeding (95% confidence interval: 1.54-1.95)). Palliative care was more consistently associated with fewer life-sustaining treatments for those with cancer. CONCLUSIONS: Palliative care is related to reduced life-sustaining treatments for patients with dementia. However, except in the case of tube feeding, which tended to be provided alongside palliative care regardless of cancer status, having cancer possibly had itself a protective effect against the use of life-sustaining treatments. Modifying the eligibility criteria for palliative care in dementia, improving awareness on the terminal nature of dementia and facilitating advance planning for dementia patients may be priorities for health policies.
BACKGROUND: The association between palliative care and life-sustaining treatments for patients with dementia is unclear in Asian countries. AIM: To analyse the use of palliative care and its association with aggressive treatments based on Taiwanese national data. DESIGN: A matched cohort study was conducted. The association between intervention and outcome was evaluated using conditional logistic regression analyses. SETTING/PARTICIPANTS: The source population comprised 239,633 patients with dementia diagnosed between 2002 and 2013. We selected patients who received palliative care between 2009 and 2013 (the treatment cohort; N = 1996) and assembled a comparative cohort ( N = 3992) through 1:2 matching for confounding factors. RESULTS: After 2009, palliative care was provided to 3928 (1.64%) patients of the dementia population. The odds ratio for undergoing life-sustaining treatments in the treatment cohort versus the comparative cohort was <1 for most treatments (e.g. 0.41 for mechanical ventilation (95% confidence interval: 0.35-0.48)). The odds ratio was >1 for some treatments (e.g. 1.73 for tube feeding (95% confidence interval: 1.54-1.95)). Palliative care was more consistently associated with fewer life-sustaining treatments for those with cancer. CONCLUSIONS: Palliative care is related to reduced life-sustaining treatments for patients with dementia. However, except in the case of tube feeding, which tended to be provided alongside palliative care regardless of cancer status, having cancer possibly had itself a protective effect against the use of life-sustaining treatments. Modifying the eligibility criteria for palliative care in dementia, improving awareness on the terminal nature of dementia and facilitating advance planning for dementiapatients may be priorities for health policies.
Entities:
Keywords:
Cross-cultural comparison; dementia; life-support care; national health programmes; neoplasms; palliative care
Authors: Li Mo; Yimin Geng; Yuchieh Kathryn Chang; Jennifer Philip; Anna Collins; David Hui Journal: J Am Geriatr Soc Date: 2021-03-02 Impact factor: 7.538
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