Alzheimer's Association Releases Recommendations Specific to End-of-Life Care

Hospice and Palliative Care Considered Particularly Helpful

The losses associated with dementia often require the transfer of a patient to the care of a nursing home or assisted living facility. The Alzheimer’s Association reports that about 57% of dementia-related deaths occur in nursing homes, and more than 50% of residents of these facilities have Alzheimer’s disease or some form of dementia or cognitive impairment.

The association has released its recommendations for addressing the unique care needs of persons with dementia at the end of life in its document entitled "Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes, Phase 3: End-of-Life Care."

Key aspects of the report include:

• The need for advance care planning discussion as soon as possible following diagnosis or facility admission
  
  
• Emphasis on person-centered palliative care tailored to the individual’s preferences, abilities, and changing needs
  
  
• The importance of training residence staff in dementia-specific end-of-life care issues, often available upon request from the hospice staff

The evidence-based recommendations include practical approaches to care, with suggestions and examples, and have received the support of more than 30 national professional and advocacy organizations, including the American Academy of Hospice and Palliative Medicine and the American Medical Directors Association.

Recommended care practices for dementia cover the following areas:

• Communication with residents and families, including educational and contact information regarding hospice care
  
  
• Assessment and care of physical and behavioral symptoms
  
  
• Psychosocial and spiritual support for residents and families
  
  
• Family participation in care
  
  
• Care coordination and communication with hospice staff
  
  
• Acknowledgment of death and provision of bereavement services

"The involvement of hospice services can provide additional, experienced staff members who are skilled at meeting the grief and bereavement needs of family members," the report states. The patient/family-centered approach of hospice can be coordinated with that of the residence staff. "Hospice staff can provide training to residential care staff that covers the types of care that hospices provide and the role of the hospice team."

Person-centered care emphasizes the importance of:

• Consistency in individualized care approaches
  
  
• Development of relationships between staff and patients
  
  
• Increasing familiarity of staff with individual residents’ needs, abilities, and preferences.

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Reprinted with permission from Quality of Life Matters, copyright 2008. Published by Quality of Life Publishing Co., Naples, FL.