Meaning and Influencing Factors of a Good Death for Community-Dwelling Individuals With Dementia: An Integrative Review.

INTRODUCTION

The rising prevalence of dementia highlights the need to ensure good quality of life for those affected. This integrative review aimed to clarify what constitutes a good death for community-dwelling people with dementia and their family caregivers and to identify structural and process factors that support or hinder its attainment.

METHODS

Using Whittemore and Knafl's integrative review approach, a literature search was conducted in PubMed, CINAHL, Embase, Scopus and Web of Science using key terms, including dementia, community-dwelling and death. Following the screening process, 21 articles were analysed using the structure-process-outcome framework.

RESULTS

Of the 21 articles included, nine explored the concept of good death, 16 addressed structural factors, and 19 examined process factors associated with quality end-of-life care that may facilitate good death. From the perspective of people with dementia and their family caregivers, a good death involves dying peacefully while preserving dignity and autonomy. Structural factors included community-based healthcare and social support resources, such as access to hospice and palliative care, a skilled professional workforce and services that support daily living and caregiver needs. Process factors included comprehensive approaches to patient care: advance care planning, symptom management, person-centred care, emergency and safety management, health management and education for family caregivers.

CONCLUSIONS

This review highlights that achieving a good death for community-dwelling people with dementia requires accessible, comprehensive, person-centred end-of-life care and robust support for family caregivers. Strengthening policies and developing integrated community care models are essential for upholding end-of-life dignity and honouring care preferences.

IMPLICATIONS FOR PRACTICE: These findings suggest that healthcare professionals should implement community-based, person-centered care models that provide structured education and psychological support for family caregivers to facilitate a 'good death' for people with dementia.