Hospice Focus: End-of-Life Care Important for Dementia Patients

Palliative care offers a more peaceful passing for patients and emotional support for loved ones.

With a growing number of older adults dying from Alzheimer's disease and other dementias, the New England Journal of Medicine recently called for greater access to palliative care—the management of pain and other symptoms for dementia patients at the end of life.

Palliative care involves a team-oriented approach to pain management and medical treatment, as well as emotional support tailored to the patient's needs. Palliative care focuses on relieving symptoms such as pain, shortness of breath, fatigue, nausea, loss of appetite and difficulty sleeping. Hospice care provides palliative care, which can be administered regardless of prognosis, along with medical treatment, and does not hasten death.

Dr. Greg Sachs believes that more research on palliative care for patients with dementia is needed to update public policy and to encourage lawmakers and insurance companies to recognize the need to support and fund care which will improve the overall health of these older adults who can no longer speak for themselves.

"Since individuals with advanced dementia cannot report their symptoms, these symptoms often are untreated, leaving patients vulnerable to pain, difficulty breathing and various other conditions. We shouldn't allow these people to suffer. We should be providing palliative care to make them more comfortable in the time they have left," said Dr. Sachs, who is a geriatrician and medical ethicist serving as director of the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine.

Sachs explains that while it is not always easy, caregivers and medical personnel should attempt to pick up on nonverbal clues of pain, such as the individual holding the body in a certain way to avoid a painful posture, or exhibiting swollen, tender joints. These observations, reported by a caregiver or found on medical examination, may help the physician make the patient more comfortable, and help identify underlying conditions.

Dr. Sachs' observations accompany a Harvard University study of 323 patients with advanced dementia. The study revealed that even in the absence of another condition such as stroke or heart attack, the dementia patients usually lived less than a year, especially in the presence of complications such as pneumonia, episodes of fever, or eating problems.

Source: Indiana University School of Medicine. Dr. Sachs leads the Indiana Palliative Excellence in Alzheimer Care Efforts Program. The program, supported by a grant from the National Palliative Care Research Center, provides improved symptom management, enhanced family support, and assistance with difficult decision making.