Hi everyone. My name is Sanae Masujima. I work as a nurse at Manor park private hospital for advanced Dementia and Mental health.

Today, I will talk about access to palliative care services for people with advanced dementia.

The objectives for this presentation are.....

As The definition of advanced dementia, dementia is a life limited disease that is progressive and be uncured.

Dementia can realistically be regarded as a terminal condition.

physical symptoms of people with advanced dementia are similar to symptoms at the end-stage of cancer.

Therefore, people with advanced dementia need palliative care in any stages to improve their quality of life.

There are some barriers to access to palliative care for people with advanced dementia.

The uncertain advanced dementia's trajectory and the lack of understanding and knowledge of advanced dementia among healthcare professionals and families lead to delay prognosis and introduce palliative care services.

the lack of understanding and knowledge about AD (healthcare professionals and families) also affect appropriate assessment and symptom management and recognition of palliative care needs.

Attitudes towards AD amongst healthcare professionals is important for the timing to access to palliative care services.

I find an interesting research about healthcare professional's attitudes of palliative care phase for people with advanced dementia in aged care sectors. The authors found that 3 different time points that the healthcare professionals consider palliative care approach- "(1) from the early stages of dementia, (2) when signs and symptoms of advanced dementia are present, and (3) from the time point that curative treatment for co-morbidities is ineffective. The different time points may affect the timing for a referral to palliative care team and palliative care approach in people with advanced dementia. Also, some healthcare professionals still think dementia is not a life limited condition.

An Inappropriate work environment for staff who care people with AD (such as shortage of staff, the lack of education and support) affects recognition of palliative care needs and a quality of palliative care.

The less connection with PC team due to an admission system. In my workplace, the most of the residents have been transferred from other aged care, mental health sectors. Therefore, we don't have much connection with a palliative care team.

The lack of Advanced care planning- most of my residents don't have advanced care planning. When they are transferred to my workplace, most of them are unable to express their preferences. Advanced care planning is important to improve a quality of palliative care and prevent unnecessary treatments.

As strategies for accessing to palliative care, education for the health care team and families is important.

Education of dementia trajectory and advanced care planning for people with an early stage of dementia and their families is to improve their understanding of dementia, decrease conflict, and distress, increase their acceptance especially at an advanced stage of dementia.

Education of AD and PC, ACP process for a health care team is to improve timely introducing ACP, appropriate prognosis, assessment and management skills, timely introducing palliative care approach, timely referral to a palliative care team, a quality of palliative care.

To use prognosis and assessment tools is to improve confidence and skills for prognosis, assessment and symptom management.

A connection between palliative care team and dementia care team is important to share our issues, improvement of palliative care for our residents. we can build the connection through training, meetings, and regular visits by the palliative care team.

It is quite challenging to care people with advanced dementia who have problems of behaviour and communication. Therefore, a supported work environment is important to maintain staff's motivation and staff retention.

We use this pain assessment tool in my workplace. Most of my residents are unable to express their pain verbally. This pain assessment tool is useful for people with non-verbal communication.

This assessment is useful to identify residents' discomfort. Also, it can use as an indicator for 6 months survival in people with dementia.

One of hospice nurses introduced me this care programme. This care programme is for people with advanced dementia in aged care.

The care programme provides sensory stimulation such as lighting, music, aroma, massage and providing fluids and snacks.

Link to Video: http://www.youtube.com/v/aWfEk7cEB8U

Link to Video: http://www.youtube.com/v/IQ8iKHdqv4Q