Dementia and the End of Life

A study appearing in The New England Journal of Medicine suggests improving palliative care for advanced dementia patients. Researchers, led by Dr. Susan Mitchell of Harvard Medical School,studied 323 nurshing home residents around Boston and found that although most patients primary care goal was stated as comfort care, over 40 percent received at least one medical intervention in the last three months of life.

Tara Parker-Pope at The New York Times also reported on the study:

Dementia is often viewed as a disease of the mind, an illness that erases treasured memories but leaves the body intact.

But dementia is a physical illness, too — a progressive, terminal disease that shuts down the body as it attacks the brain. Although the early stages can last for years, the life expectancy of a patient with advanced dementia is similar to that of a patient with advanced cancer.

The lack of understanding about the physical toll of dementia means that many patients near the end of life are subjected to aggressive treatments that would never be considered with another terminal illness. People with advanced dementia are often given dialysis and put on ventilators; they may even get preventive care that cannot possibly help them, like colonoscopies and drugs for osteoporosis or high cholesterol.

“You can go to an intensive-care unit in most places,” said Dr. Greg A. Sachs, chief of general internal medicine and geriatrics at Indiana University School of Medicine, “and you’ll find people with dementia getting very aggressive treatment.”