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Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study

Chen, P-J; Liang, F-W; Ho, C-H; Cheng, S-Y; Chen, Y-C; Chen, Y-H; Chen, Y-C; (2018) Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study. Palliative Medicine , 32 (3) pp. 622-630. 10.1177/0269216317751334. Green open access

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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.

Type: Article
Title: Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0269216317751334
Publisher version: https://doi.org/10.1177/0269216317751334
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cross-cultural comparison, dementia, life-support care, national health programmes, neoplasms, palliative care
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10070657
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