Word: carefulness
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...stage dementia patients. Dr. Greg Sachs at the Indiana University Center for Aging Research says a lack of appreciation of the nature of dementia leads to misguided and often overly aggressive end-stage treatment. Five years ago, Sachs wrote a paper on such barriers to palliative end-of-life care for dementia patients, but he ran into difficulty explaining the findings to the editors of the major medical journal that published it. "The editors kept coming back to me and saying, 'But what do the patients die of? You don't die from dementia.' And I kept saying, 'Yes, they...
...toward identifying the true course of the slow-progressing disease, which affects some 5 million Americans - a number that is expected to triple by 2050. "This is the first large study to show what specialists have been arguing for years. Dementia is a terminal illness, and patients warrant palliative care," says Sachs, who wrote an editorial that appears in the same issue of the journal...
...home residents with advanced dementia for 18 months. These patients were unable to recognize family members, incontinent and unable to get around on their own. Researchers tracked the progression of their disease, complications and survival rates; they also recorded the treatments each patient received as well as their health-care proxies' understanding of advanced dementia and the patient's prognosis. Over the course of the study, 55% of the residents died, with nearly half of those deaths occurring within the first six months of the study. Patients' median survival span was 478 days, a figure comparable with that of terminal...
When those systems fail, patients are often treated aggressively rather than with palliative care. More than 40% of residents who died over the course of the study were sent to the emergency room, hospitalized, tube-fed or given IV nutrition during the last three months of life. These interventions can themselves cause distress and pain while providing, at best, questionable benefit and minimal prolongation of life, experts say. Among the family members who directed these residents' care, however, those who believed that the resident had less than six months to live and understood the nature of advanced dementia were less...
Experts say part of the reason it is so common to intervene in dementia cases is that the patient, by definition, cannot make medical decisions autonomously, leaving a relative or friend to serve as their health-care proxy. "Family members are much less likely to forgo treatments or let go. An 80-year-old patient will tell you, 'I have lived a good, long life. I have no regrets.' But talk to his 50-year-old son, and he isn't ready. Being the decision maker for someone else is a much harder thing to do," says Sachs, who says...