Development and evaluation of the REACH (recognise end of life and care holistically) out in dementia toolkit.

Aim: To identify evidence based signs and symptoms indicative of end stage dementia, and develop the REACH toolkit as an aid for staff to consider a palliative approach.

Method: A systematic literature review was conducted of policy, position documents, guidelines and publications from 1988 to 2011. Inclusion criteria were any report or article identifying the signs and symptoms of end stage dementia which were associated with increased mortality and morbidity.

Results: Eight signs and symptoms associated with worsening function and increased mortality were identified. These were incorporated into a toolkit. Experienced clinicians reviewed the toolkit. It was then trialled in six aged care facilities (ACFs) and as a result of the trial 182 residents with dementia were identified as being at the end stage.

Conclusions: Use of the toolkit improved the recognition of end stage dementia among staff in ACFs.