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Referral criteria to specialist palliative care for patients with dementia: A systematic review
Author(s) -
Mo Li,
Geng Yimin,
Chang Yuchieh Kathryn,
Philip Jennifer,
Collins Anna,
Hui David
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.17070
Subject(s) - medicine , dementia , referral , palliative care , cinahl , medline , family medicine , disease , psychological intervention , psychiatry , nursing , political science , law
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.