Provision of palliative care for patients with advanced dementia across various long-term care settings in Japan: a facility-based survey

Objective: This study aimed to assess the proportion of long-term care settings that deliver palliative care services to older clients with advanced dementia and identify trends across different facility types in Japan. Participants and Methods: A nationwide cross-sectional facility-based survey was conducted between November 2022 and January 2023. The survey targeted 3,000 long-term care facilities, including 1,000 geriatric hospitals, 1,000 geriatric health service facilities, and 1,000 home nursing care stations. Palliative care practices were assessed using an eight-item scale covering pain assessment, symptom management, spiritual care, and family support. Results: Less than half of the geriatric hospitals supported family participation or addressed the spiritual needs of older clients with dementia, although most conducted pain assessments and prescribed analgesics. In the geriatric health service facilities, fewer than half used pain assessment tools or supported family caregivers' distress and involvement. In contrast, more than 80% of the home nursing care stations reported implementing most of the listed palliative care practices. Conclusion: Palliative care provisions for older adults with advanced dementia vary considerably across long-term care settings in Japan. These findings highlight the need to develop specific strategies to enhance palliative care delivery in institutional and community-based settings.