By
Jennifer B. Buckley
A new study released, suggests more than 50% of people living with
end-stage Dementia caused by Alzheimer’s Disease or Vascular Dementia,
will die within 6 months of developing pneumonia or fracturing a hip.
Similar to cancer, end-stage dementia is a terminal illness and the study
encourages a more palliative or comfort approach to care rather than
having the patient endure invasive testing and treatments if they receive
a poor prognosis. The study was conducted by researchers at the Mount
Sinai School of Medicine in Manhattan and published in the Journal of the
American Medical Association. The approach to treatment should ultimately
be left to the caregiver or loved one as the person with advanced dementia
or Alzheimer’s disease is probably mentally incapable to make the
decision.
End-stage dementia affects 1.8 million Americans and is categorized by a
patient’s inability to recognize friends or family members, perform
daily tasks like, dressing or bathing, or lack communicative skills. Many
people with advanced stage Alzheimer’s experience repeated infections
and other complications and physicians do not have enough research
currently, to treat patients for these common conditions.
The study compared 216 advanced dementia patients and cognitively intact
adults, which were hospitalized for either pneumonia or a fractured hip,
and examined their six- month survival. Pneumonia and hip fractures were
chosen because they are common in both groups and associated with notable
pain and discomfort.
The results of the study concluded a high six-month mortality rate for
people with end-stage dementia compared with the cognitively intact adults
when admitted into the hospital for pneumonia (53% compared with 13%) and
for hip fractures (55% compared with 12%).
Both groups of patients received almost identical care practices in their
hospital stay including; painful diagnostic and therapeutic procedures
which can be extremely frightening for an end-stage dementia patient who
doesn’t understand what is happening to him or her. However, the
patients with end-stage dementia received less pain medication than the
cognitively intact adults. “The under treatment of pain in dementia
patients likely results from the fact that these patients often cannot
communicate what they are feeling or that they are in pain,” according
to Dr. R. Sean Morrison, Assistant Professor, The Lillian and Benjamin
Hertzberg Palliative Care Institute at Mount Sinai. Doctors and nurses
sometimes don’t realize these patients are in pain so “standing
orders” for pain medication such as morphine should be given, meaning
with or without the expressed interest of the patient.
This new evidence will help to persuade doctors and caregivers to view
pneumonia or hip fractures as a terminal illness in advanced stage
Alzheimer’s patients, even with aggressive treatment. Therefore,
communication about the course of treatment should be established between
the physician and caregiver, weighing the patient’s level of comfort
against life-prolonging treatments. Caregivers, caring for a loved-one
with end-stage dementia or Alzheimer’s, should communicate interest to
their doctor’s about more comprehensive palliative care. This will
ensure more comfort for their loved-one during their end-of-life care.
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