Word: dementias
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Dates: during 2000-2009
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That distinction is largely unfamiliar both to the general public and within the medical field, yet it is a crucial one when it comes to treatment decisions for end-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...
...England Journal of Medicine goes a long way 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...
...study followed 323 Boston-area nursing-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...
...Dementia is not a single illness but a collection or consequence of many, including Parkinson's disease, vascular dementia and Alzheimer's disease (which accounts for some 70% of all dementia cases). In the advanced stages of dementia, it is often impossible to tell which disease the patient had at the outset, as the end result is the same, according to Mitchell's study: a syndrome of symptoms and complications - eating problems (86%), pneumonia (41%), difficulty breathing (46%), pain (39%) and fever (53%) - caused by brain failure. "Dementia ends up involving much more than just the brain," says Dr. Claudia...
...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 likely to intervene aggressively than caregivers who lacked such understanding. "Clinicians, patients' families and nursing-home staff need to recognize and treat advanced dementia as a terminal illness requiring palliative care," wrote Sachs in his editorial, noting that patients need not be close to death to warrant pain...