Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Major overhaul needed in end-of life care for patients with dementia

14.10.2004


Three University of Chicago geriatricians are calling for creative and wide-reaching solutions to the problem of sub-optimal end-of-life care for patients with dementia. An estimated 500,000 people die every year in the United States suffering from Alzheimer’s or related diseases and many of them receive inadequate pain control, are subjected to ineffective and invasive therapies such as tube feedings, and do not receive the benefits of hospice care.



"The nature of the illness is the root cause of the problem," said Greg Sachs, M.D., professor of medicine, section chief of geriatrics at the University of Chicago and first author of the study. "Our health care system is oriented toward treatment of acute illness but dementia produces a long, slow, unpredictable decline."

Their study is one of four in the October, 2004, issue of the Journal of General Internal Medicine that focus on the expanding role of primary care physicians in the care of patients with chronic and ultimately terminal illness – a growing, difficult problem for physicians and for society.


Death used to come quickly, but now it "fades in slowly -- over years or even decades," notes Christopher Callahan, M.D., of the Indiana University Center for Aging Research, in an editorial that ties together the four papers. The pace of death, he adds, "has slowed so suddenly that we seem to have lost our ability to recognize it." As a result, "we find ourselves poorly trained, our systems poorly designed, and our patients and communities poorly equipped." "All the barriers and problems seem to converge," he adds, in end-of-life care for patients with dementia.

The Chicago geriatricians list the barriers to optimal care for such patients and suggest ways to get past them. The first hurdle is the unwillingness of physicians and families to think of dementia as a terminal illness. Patients with dementia decline slowly, with long periods of stability punctuated by sudden declines and partial recovery. The proximate cause of death is usually a complication of the dementia, such as pneumonia or other infection, often triggered by the decreased mobility that comes with advanced dementia.

A second barrier is the inability of physicians to predict the time of death. Medicare and most insurance plans offer hospice benefits only to patients with a life expectancy of six months or less, but the median survival for patients with dementia is several years and varies enormously. Patient assessment becomes even more difficult as the dementia advances and the patient can no longer describe his or her symptoms or notify caregivers of discomfort. A third barrier is the poor fit between dementia and health care financial incentives, which reward providers for transferring rapidly declining patients into hospitals – where the process of dying is prolonged. "The only parties who may not be better off from the transfer," note the authors, "are the patient and family."

The solutions involve education, better prognostic tools, and changes in the health care system. Geriatrics, dementia, and palliative and end-of-life care are all under-represented in medical school curricula and deserve more attention as the numbers of elderly continue to increase. Physicians also need to educate the public, to create a baseline of awareness before families have to face these issues directly and make difficult decisions about a loved one.

Better prognostic tools for patients with dementia and increased access to hospice care are needed. Improved quality-assessment tools and regulatory guidelines that promote comfort care when appropriate could encourage better care for patients with dementia in nursing homes. Perhaps most urgent, however, is a nationwide effort to "align the financial incentives in the system with the provision of palliative care." The authors suggest relaxing the criteria for hospice to accommodate earlier referral of patients with dementia. Nursing homes should be financially rewarded for providing good end-of-life care rather than for transferring dying patients to a hospital.

Finally, caregivers need to shift away from the reigning concept of a sudden, and usually quite late, switch from curative to palliative care. Instead, they should develop new models based on a gradually changing blend of curative, restorative and palliative care services as patients decline and goals are adjusted. With funding from the Robert Wood Johnson Foundation, the authors have developed an innovative program entitled Palliative Excellence in Alzheimer Care Efforts (PEACE) that successfully demonstrated how improved symptom management, greater hospice referral, and facilitating death at home rather than the hospital can be achieved for people with dementia. The problem "requires fundamental action at the level of health systems, economics and public policy," concludes Callahan.

John Easton | EurekAlert!
Further information:
http://www.uchospitals.edu

More articles from Health and Medicine:

nachricht Finnish research group discovers a new immune system regulator
23.02.2018 | University of Turku

nachricht Minimising risks of transplants
22.02.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Attoseconds break into atomic interior

A newly developed laser technology has enabled physicists in the Laboratory for Attosecond Physics (jointly run by LMU Munich and the Max Planck Institute of Quantum Optics) to generate attosecond bursts of high-energy photons of unprecedented intensity. This has made it possible to observe the interaction of multiple photons in a single such pulse with electrons in the inner orbital shell of an atom.

In order to observe the ultrafast electron motion in the inner shells of atoms with short light pulses, the pulses must not only be ultrashort, but very...

Im Focus: Good vibrations feel the force

A group of researchers led by Andrea Cavalleri at the Max Planck Institute for Structure and Dynamics of Matter (MPSD) in Hamburg has demonstrated a new method enabling precise measurements of the interatomic forces that hold crystalline solids together. The paper Probing the Interatomic Potential of Solids by Strong-Field Nonlinear Phononics, published online in Nature, explains how a terahertz-frequency laser pulse can drive very large deformations of the crystal.

By measuring the highly unusual atomic trajectories under extreme electromagnetic transients, the MPSD group could reconstruct how rigid the atomic bonds are...

Im Focus: Developing reliable quantum computers

International research team makes important step on the path to solving certification problems

Quantum computers may one day solve algorithmic problems which even the biggest supercomputers today can’t manage. But how do you test a quantum computer to...

Im Focus: In best circles: First integrated circuit from self-assembled polymer

For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.

In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Basque researchers turn light upside down

23.02.2018 | Physics and Astronomy

Finnish research group discovers a new immune system regulator

23.02.2018 | Health and Medicine

Attoseconds break into atomic interior

23.02.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>