An estimated 4 million parts in th...

An estimated 4 million parts in the United States generally have Alzheimer's disease. This cluster and the general aging of the population place increased demands forward the health care system. End-of-life care for patients with Alzheimer's disease and other progressive dementias has implications for patients, caregivers, and society. Families of patients at this stage of dementia must determine if they can provide care at to one's home or if the patients should be cared for in an institution. Quality of care in patients with end-stage dementia is an important factor when deciding where these patients should receive care. If satisfactory care cannot be provided at household patients with progressive dementia should receive end-of-life care in an institution. commonly no studies have examined the quality of care for patients with progressive dementias in either setting. Volicer and associates evaluated end-of-life care of patients with dementia and gazeed at the various outcomes.

The authors guidanceed a retrospective survey of a national sample of family caregivers of patients with dementia who died within the same year from the start of the research The authors developed a Caregiver Assessment of End-of-Life in Dementia Questionnaire. Copies of the questionnaire were delivered to Alzheimer's Association chapters, Geriatric Research Education Clinical Center and the National Institutes of Health Alzheimer's Disease Center who agreed to participate in the reflection These organizations distributed the questionnaire to caregivers of patients with dementia who had died within the previous year. The overlook consisted of multiple components concerning end-of-life issues and gathered information about the bulk of care required by the patient, the caregiver carrying capacity an index of assistance, and the quality of care. Care settings were defined as those in which patients exhausted their last 90 days--at family circle at home and an institution, or at an institution.

The patients with dementia who were cared for at a loved one were 81 years of age forward average, 55 percent were men with 42 percent completely hanging for all aspects of daily living. Patients who received hospice care and pain direct stayed at home longer and were more likely to die at residence The main reason for increased caregiver lading and institutionalization was psychiatric symptoms. Patients who had advance directives had decreased hospital stays and an increased likelihood of dying in a nursing domestic circle Patients who died at abiding-place had fewer symptoms and les discomfort than those who received care in other settings.

The authors infer that quality end-of-life care can be provided at family for patients with progressive dementia. This care can be facilitated according to hospice programs, effective pain rule and psychiatric care. The authors add that residence care could reduce health care outlays and promote care for these patients in the settings that in the greatest degree patients prefer.

Volicer L et al. Characteristics of dementia end-of-life care across care settings. Am J Hospice Palliat Care May/June 2003;20:191-200

COPYRIGHT 2004 American Academy of Family Physicians

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