People on average are now living longer than ever before, and with advancing age comes the associ- ated risk of dementia. Patients with dementia may suffer the same symptoms and are entitled to the same level of care as their cognitively intact counterparts, but different principles must be applied. The cognitive impairment that results in dementia also makes adequate pain management challenging (Chang et al, 2009; Jordan, 2010). The author supports the use of a specialized pain assessment tool that incorporates behavioural cues as part of the assessment to prevent pain from being undertreated. An analgesic trial can act as a guide to the presence of pain: if the patient is observed to be more comfortable or less agitated after the admin istration of analgesia, it can logically be acknowledged that pain must have been present. Similarly, patients with advanced dementia may present with difficulties with nutrition/hydration and dyaphagia, and these do not always signify that the patient is dying. Decision making regarding theadministration of artificial fluids or nutrition is complex and requires knowledge about advanced dementia as a disease and the benefits and burdens of administration.
Expertise from specialists in both dementia
care and palliative care needs to be combined if
patients are to be provided with the best possible
end-of-life care. When consulted, SPC nurses
must have the necessary knowledge and experi
ence to be able to provide evidence based advice
and recommendations. Further research is
required to identify and address areas of contro
versy. This research will provide a more extensive
body of evidence on which guidelines could be
formulated. These guidelines could act as means
to assist in the decision making process when
SPC nurses encounter the various different dilem
mas that are posed in caring for patients with
dementia. The guidelines would also be helpful in
the education and specialist training of staff