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People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and recommendations, but the domain concerning the applicability of palliative care to dementia required revision.
To examine in detail, the opinions of the international panel of 64 experts around the applicability of palliative care, we explored feedback they provided in the Delphi process. To examine which experts found it less important or less applicable, ordinal regression analyses related characteristics of the panelists to ratings of overall importance of the applicability domain, and to agreement with the domain's four recommendations.
Some experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling dementia care as palliative care. Multivariable analyses with the two outcomes of importance and agreement with applicability indicated that younger or less experienced experts and those whose expertise was predominantly in dementia care found palliative care in dementia less important and less applicable.
Benefits of palliative care in dementia are acknowledged by experts worldwide, but there is some controversy around its early introduction. Further studies should weigh concerns expressed around care receiving a “palliative” label versus the benefits of applying palliative care early.
The Working Party on Security in NHS Hospitals (The Glancy Report, DHSS, 1974a) and the interim report of The Butler Committee (DHSS, 1974b) both recommended that secure provision should be made available for the treatment of mentally disordered patients who required greater security than could be provided in a standard hospital setting. They recommended that patients with mild or borderline mental handicap should be treated together with the mentally ill but that “severely subnormal patients” should be treated separately. Later the Royal College of Psychiatrists (1981) largely endorsed this advice proposing that:
(a) individuals with borderline and mild mental handicap could be adequately treated in the secure units for mentally ill individuals
(b) individuals with moderate mental handicap needed a special secure facility
(c) individuals with severe mental handicap did not need high security, and should be managed in high-staffed wards in mental handicap hospitals.
Almost all sleep-promoting drugs distort the natural pattern of sleep by suppressing rapid eye movement (REM) sleep, and cause a rebound to above-normal values on withdrawal which typically lasts about six weeks (Oswald, 1968, 1969). Furthermore, barbiturates reduce the number of eye movements per unit time in REM sleep (Oswald et al., 1963; Baekeland, 1967; Lester et al., 1968; Feinberg et al., 1969), with a rebound in eye movement (EM) profusion on withdrawal (Oswald, 1970). Non-barbiturate hypnotics do likewise, also with a rebound in EM profusion on withdrawal (Allen et al., 1968; Lewis, 1968).