失智症者之緩和照護

Palliative Care for Persons With Dementia

失智是不可逆的疾病，目前只有藥物可以減輕症狀及緩和病程進展，但卻無法治癒，因此漸近退化或病情惡化進入末期失智是不可避免的結果。提供舒適及良好生活品質的緩和照護應被列為末期失智症優先考量的照護計畫，然而失智症卻很少被視為末期疾病。台灣已於2009年將失智者納入健保安寧緩和服務給付對象，本文將就末期失智者之處境及其他國家發展失智症緩和照護所遭遇之障礙進行討論，並提出建議策略，促進末期失智患者獲得良好的照護及生活品質。

Dementia is irreversible. Although currently available drugs are typically able to ameliorate symptoms and slow down its progress, there is yet no known cure for this disease. The inevitable consequence of dementia is the gradual deterioration of the condition until final decline into the end of life stage. The priority care plan for patients with end stage dementia, therefore, must focus on palliative care that provides for a comfortable and high as possible quality of life. However, dementia is rarely looked upon as an end-stage disease. In 2009, the Taiwan National Health Insurance began reimbursing the costs of hospice care for patients with end stage dementia. This paper discusses end stage dementia cases in which patients received inappropriate interventions during their final days as well as the barriers faced in developing countries to providing palliative care. This paper also suggests strategies to promote quality of care and quality of life in people with end of life dementia.