摘要
隨國人平均年齡逐漸老化，失智症病人的盛行率及發生率也隨之顯著增加。失智症目前仍爲不治之病，除了病程進展較緩慢以外，失智症晚期病人的臨床症狀繁雜且病程變化多端，和癌症末期病人多樣化的症狀需求非常類似。因此，安寧照護運用於失智症晚期病人及家屬的照護在西方國家逐漸普及和引起廣泛探討。安寧照護在失智症的角色有二，其一爲針對病人提供進一步的症狀緩解、瀕死護理及預後評估；其二爲針對家屬加強照顧者對疾病病史、預後認知及哀傷輔導。失智症病人接受安寧照護常見的爭議包括：失智症病人小於6個月存活期時間點判斷困難、失智症爲是否爲末期疾病的認定、安養機構提供安寧照護的能力是否足夠、人工營養及水分的必需性、失智症病人的自主性如何認定、如何評估家屬的感受與哀傷輔導，以及意識不清病人如何評估疼痛需求等等。 非癌症病人的安寧照護在台灣剛剛起步，本文從文獻的回顧，對有關失智症接受安寧照護的必須性及失智症病人接受安寧照護常見的困境作一探討。
並列摘要
As the life expectancy has increased, the prevalence and incidence of dementia has increased significantly. Currently, dementia is still considered an incurable disease. Other than slow disease progress, clinical symptoms of advanced dementia are complicated and with great variations similar to those found with terminal cancer patients. Therefore, there is a wide spread discussion in the Western countries about applying palliative care to advanced dementia patients and families similar to those with terminal cancer. There are two roles for palliative care in dementia. One is to provide proactive symptom alleviation, prognostic evaluation and dying care. The other is to focus on educating families about the natural course of the disease, its prognosis and grief counseling. There are some controversies in applying palliative care to dementia patients, including challenges of determining less than 6-months of life prognosis, recognition of dementia as a terminal illness, capabilities of nursing homes to provide proper palliative care, necessities of artificial feeding and fluid supplement, evaluation of patient's autonomy, assessments of patient's family's emotions and need for grief counseling, and determining required pain relief for unconscious patients. Palliative care for non-cancer patients has just begun in Taiwan. This article reviews the literature and discusses the needs and challenges of dementia patients receiving palliative care.
被引用紀錄
延伸閱讀
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