Despite having complex needs, most of the healthcare received by people in the later stages of dementia is provided by GPs, with little support from specialist healthcare professionals, according to research published in the journal Palliative Medicine.
It found that GPs are the main providers of medical care for these patients, with 96% of patients seeing a GP in their last month of life.
Around one in five (19%) were seen by a paramedic in the month prior to their death, suggesting a reactive rather than planned response to patients’ needs.
Just 1% of people with advanced dementia were seen by a geriatrician or an older person’s psychiatrist during the study’s follow-up period.
The researchers, from the Marie Curie Palliative Care Research Department at University College London, warned that healthcare services are ‘not currently tailored to the complex needs and symptoms of people with advanced dementia’.
GPs carrying out home visits were ‘not supported by specialist services’, they added, and care homes were ‘poorly served by secondary healthcare services’.
Marie Curie’s Dr Liz Sampson - lead author of the study - said: ‘Complex symptoms require active specialist intervention, multidisciplinary working and effective care co-ordination but many GPs are not supported by these services and feel that they do not have the time or knowledge to do this themselves.
‘The system isn’t currently fit for purpose. We need to see more resources provided in the community and nursing home staff receiving more support from external healthcare services.’
RCGP chair Professor Helen Stokes-Lampard said: ‘We will always do what we can in the best interests of the patient in front of us, but patients at or nearing the end of their lives, particularly those with advanced dementia, have very complex health and social care needs.
‘GPs are generalists – by definition we are not specialists in geriatric medicine, or psychiatry – so when our patients need input from specialist services, it is essential that they have access to them and that we have the technology to enable effective communication.
‘We need to be supported at both a national and local level by commissioners, so that we have adequate support to deliver the care that our patients at or nearing the end of their lives – whatever their unique circumstances – need and deserve, at a time when they are incredibly vulnerable.’