Family Carer Perspectives of Quality End
of Life Care for Dementia
Nathan Davies1, Greta Rait1 and Steve Iliffe1
1UCL,
Research Department of Primary Care and Population Health, Royal Free Campus, Rowland Hill St., London,
NW3 2PF
Background
Method
There are 670,000 family carers of people with dementia in the UK (1), they are experts through
experience, often spending 24 hours a day with the person with dementia and having spent
Design
either lifetimes together through marriage or ears being brought up by them as children. They
Qualitative methodology using in-depth interviews
often know their wishes, like and dislikes incredibly well and are able to reflect this in their end of
life care.
Participants
The majority of research which has looked at family carers in dementia has focussed its efforts
•
Family carers of people who are currently dying with dementia
•
Bereaved family carers of someone with dementia
on:
• Early stages and diagnosis
Procedure
• Transition stages
• Participants were purposively sampled through Dementia UK a national charity which
• stresses and burden of caregiving
organises a register of carers who are willing to participate in research.
• Feelings of guilt or bereavement (2,3)
• A topic guide was developed from literature reviews of the field, it was then tested and
changed iteratively throughout the interviewing process.
We know very little about the experiences of caring for someone with dementia at the end of life
(4).
Aim
• Face to face interviews were conducted however telephone interviews were conducted when
requested by participants.
• Interviews were transcribed verbatim and a mixture of thematic and narrative analysis will
This study aims to explore what are the features of good quality end of life care someone with
continue to be completed on the data.
dementia from the perspective of family caregivers.
Results
Communication
After death care
“he (Dad) would say to me you killed your mother you b**ch […]
you are a cursed child you should have been killed the day you
were born […] and I was thinking I don’t get this guy, and at this
point I had still been told nothing about the illness” (Daughter)
“[…] watched them [undertakers] carrying her down the stairs, you know in sort of a
black body bag and that was, that was horrible. I felt really, as if at that point we
maybe shouldn't have been there, we maybe should have been sat in the lounge […] I
mean because she was vertical at one point, because they were negotiating bends in
the stairs […] we could have been alleviated from that” (Daughter)
Communication
“[on calling the GP after her Dad had died] the GP said to
me what the hell have you done to your Dad” (Daughter)
Personalisation of care
“there was a caretaker there who was just a lovely guy, and
Dignity
“For me to do that to my Dad [personal care] I
was cursing him… it was very grave situation”
um because my dad was quite sprightly, very, very physically
Quality of care
fit, um he was really good with my dad, and he said, ‘Come
on Jack, we’re going to B&Q,’ and he’d take my dad along to
B&Q. My dad thought that he was working there. He was
always grumbling about not getting paid” (Daughter)
Compassion
“I asked them [hospital staff] not to put him next to the electrical box, but
they ignored this, and put him there anyway. He thought the coloured tags
attached to his cannula were the keys to open the electrical box so he
pulled out his cannula, making his arm bleed copiously. There was blood all
over the pillow, but the nurse just turned the pillow over. The nurse said
Fear
“An auxiliary nurse came back in and told him to ‘sit the f***
down’. I saw this when I was there, which made me only wonder
what happened when I wasn’t there. No matter what anyone says
you cannot say anything to the nurses because you are leaving
your loved one at their mercy” (Daughter)
that “my father was nothing but a problem”” (Daughter)
Conclusions
•
Quality is not hard to achieve in many situations – its taking care back to it’s basics and respecting the person with dementia right through to the end of their life
•
There is a large spectrum about what quality of care actually means to carers, quality of care is personal and individual, it means different things to different people. What one judges to be good
quality care is not what another one does.
•
Good end of life care doesn’t mean saturating people with dementia with lots of treatment but it also doesn’t mean giving up on them
•
A patients care is not separate from a carers care – they should be integrated to achieve high quality care
References
(1) Alzheimer’s Society (2013). Dementia 2013 infographic. From http://www.alzheimers.org.uk/infographic. Accessed 03 May 2013.
(2) Peacock SC. The experience of providing end-of-life care to a relative with advanced dementia: An integrative literature review. Palliative & supportive care. 2012;11(2):155-68.
(3) Raymond M, Warner A, Davies N, Manthorpe J, Ahmedzhai S, Iliffe S. Palliative care services for people with dementia : A synthesis of the literature reporting the views and experiences of professionals and family carers. Dementia: the international journal of social studies. DOI: 10.1177/1471301212450538. Epub ahead of
print August 10, 2012.
(4) Sampson EL, Burns A, Richards M. Improving end-of-life care for people with dementia. Br J Psychiatry. 2011;199(5):357-9.
If you would like further information please contact:
Nathan Davies: nathan.davies.10@ucl.ac.uk
Funding source: This research has received funding from the [European Union's] [European Atomic Energy Community's]
Seventh Framework Programme ([FP7/2007-2013] [FP7/2007-2011]) under grant agreement n°[258883] .