People with End-Stage Alzheimer’s Need More Palliative Care

~Jennifer 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.

 Raleigh Geriatric Care Management:

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