Nursing Interventions in Palliative Care for Advanced Dementia: A Systematic Review of Symptom, Relief, Comfort, and Caregiver Support.

Purpose: Individuals with advanced dementia often endure high symptom burden and receive limited specialized palliative care. Nurses play a central role in delivering end-of-life care, yet the impact of nurse-led interventions remains underexplored. This review synthesizes available evidence on nursing-led approaches, with a focus on symptom relief, patient comfort, and caregiver support. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Four databases (PubMed, Embase, CINAHL, and Cochrane Library) were searched for studies published between January 2015 and March 2025. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and non-randomized studies evaluating nurse-led palliative interventions in institutional or community dementia settings. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. Data extraction focused on intervention types, delivery modes, nurse training, and clinical outcomes. Results: Twenty-three studies from 12 countries were included (8 cluster RCTs, 9 individual RCTs, 6 non-randomized trials). Nurse-led programs improved care planning (≥75% documentation rates), reduced caregiver decisional conflict (20-30%), and enhanced communication quality (by up to 20 percentage points). Pain detection increased by 41%, with validated tools reducing pain scores by up to 30%. Psychosocial therapies reduced agitation by up to 25% and improved care cooperation. Multicomponent models decreased emergency visits and improved transitions, with over 40% increases in advance directive completion. Risk of bias varied by design and domain. Conclusion: Nurse-led palliative care interventions show consistent benefits in communication, symptom control, and caregiver support. However, evidence on long-term caregiver outcomes is limited, and heterogeneity in design and measurement limits comparability. Standardized, scalable models are needed to fully integrate nursing-led approaches into palliative dementia care.