重度失智症末期照護之議題

失智症是一種漸進退化性疾病，隨著病情惡化與功能減退進入重度失智是不可避免的結果。至今重度失智者於生命末期常經歷人工管灌、靜脈輸液、廣泛抗生素使用、反覆住院接受積極檢查與治療、心肺復甦術、及疼痛控制被忽略等處境，本文將討論這些處置對善終的影響，從疾病特性及情境因素分析失智症末期照護所遭遇之障礙，並提出發展有利失智者身心舒適之處置、創造支持性環境、推廣失智末期照護教育、擴展末期照護資源等策略，以改善或提升重度失智者末期照護的品質。
Dementia is a gradually degenerative disease. An inevitable consequence of dementia is the person's condition will gradually deteriorate and functionally decline into the end of life stage. To date, people with advanced dementia often suffer from feeding tube in place, intravenous fluids, systemic antibiotics, laboratory test and aggressive treatment at re-hospitalization, cardiopulmonary resuscitation and inadequate pain control during their end of life stage. In this paper we discuss how impact the good death when persons with advanced dementia under these interventions, and analyze the barriers to provide end of life care from the frame of dementia characteristics and situational factors. We also suggest some strategies, such as developing the comfort intervention, creating supportive environment, disseminating education and setting up the resources for end of life care with advanced dementia to improve or promote the quality of care for people with advanced dementia.