TR-NPS in advanced dementia mark a threshold for timely recognition and a shift from further pharmacologic escalation toward proportionate, goal-concordant, dignity-preserving care that explicitly addresses multidimensional suffering and aligns with patient values. Early, collaborative involvement of specialist palliative care teams, together with structured caregiver support, may reduce unwarranted variation and promote consistent, person-centered practice across community and hospital settings. Future work should operationalize criteria and referral triggers for TR-NPS, develop setting-adaptable decision tools and pathways, and evaluate models of early palliative care comanagement using outcomes that emphasize comfort and dignity for patients and caregivers.
O'Hara-Veintimilla et al. (Wed,) studied this question.