Burdensome Interventions Common in Final Year of Life for Dementia Patients in Singapore
A new study by researchers from Duke-NUS Medical School reveals that almost all community-dwelling older adults with advanced dementia in Singapore experience at least one perhaps burdensome intervention in their last year of life. The findings highlight an urgent need for new strategies to support families and reduce unnecessary interventions at the end of life.
Although the number of individuals living with dementia in the Asia-Pacific region is projected to rise to 71 million by 2050, current understanding of the last year of life with dementia is mostly informed by studies conducted in western contexts.
Published in the Journal of Gerontology: Medical Sciences, the study, examining individuals with dementia’s care experience in their last year of life in Singapore, found that 92 percent of older adults with advanced dementia experienced burdensome interventions such as feeding tubes or restraints-approaches that experts say may not improve comfort or survival.
from surveys, the researchers found that the following key issues affected the quality of end-of-life care experienced by older adults with dementia living at home:
- Overreliance on burdensome medical interventions: Nearly all older adults experienced taxing interventions in their final year of life, including antibiotics (49 percent), IV fluids (22 percent), and feeding tubes, restraints, or both (74 percent).The proportion of tube-fed older adults was significantly higher than in western contexts, and tube feeding often triggers the use of physical restraints to prevent tube removal. Clinical guidelines recommend careful hand feeding instead of tube feeding.
- High hospitalisation rate: Almost half (48 percent) of older adults were hospitalised for at least a night in their final year, and 35 percent died in hospital-proportions notably higher than in western studies where long-term