Palliative assessment in dementia Pa Pain Depressi ssion Anxi - PowerPoint PPT Presentation

Palliative assessment in dementia

Pa Pain Depressi ssion Anxi xiety Psyc sychosi sis De Deliriu lirium DI DIST STRESS ESS

Rule 1 • All observed behavior is a normal reaction to an abnormal situation.

Rule 2 • Treat the symptoms and adapt the situation, Do not ‘treat’ behaviour.

Rule 3 • All observed behavior is a normal reaction to an abnormal situation. Your job is to establish what the abnormal situation is…..

Challenges of assessment • Understanding of symptoms. • Communication. • Getting investigations. • What does the person with dementia want?

Does the person with dementia understand their situation?

Is this investigation going to change the potential outcome?

Have decisions already been made? • Power of Attorney. • Advanced decision. • Advanced statements. • Collateral.

Assessment Tools

Questionnaire Informant Observational

Abbey pain scale, Doloplus-2 NOPPAIN, PAINAD, PACSLAC

Depression: • Geriatric Depressions Scale • Cornell Scale for Depression in Dementia Anxiety: • The Worry Scale • RAID

Psychosis: • Neuropsychiatric Inventory

Patient Assessment Collateral tools Observation Investigations

Best Guess Theory Experience

Treatment ladder

Aggressive Agitated Behaviourally disturbed Distressed

• Disability Distress assessment Tool – DissDAT • Discomfort Scale – Dementia in Alzheimer’s type - DS-DAT • Distress Recognition Tool - DRT

Finally…… Don’t forget rule 1 • All observed behavior is a normal reaction to an abnormal situation.

georgecrowther@nhs.net