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 New 3-D imaging reveals how human cell nucleus organizes DNA and chromatin of its genome
28.07.2017 | University of California - San Diego

nachricht Malaria Already Endemic in the Mediterranean by the Roman Period
27.07.2017 | Universität Zürich

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: Abrupt motion sharpens x-ray pulses

Spectrally narrow x-ray pulses may be “sharpened” by purely mechanical means. This sounds surprisingly, but a team of theoretical and experimental physicists developed and realized such a method. It is based on fast motions, precisely synchronized with the pulses, of a target interacting with the x-ray light. Thereby, photons are redistributed within the x-ray pulse to the desired spectral region.

A team of theoretical physicists from the MPI for Nuclear Physics (MPIK) in Heidelberg has developed a novel method to intensify the spectrally broad x-ray...

Im Focus: Physicists Design Ultrafocused Pulses

Physicists working with researcher Oriol Romero-Isart devised a new simple scheme to theoretically generate arbitrarily short and focused electromagnetic fields. This new tool could be used for precise sensing and in microscopy.

Microwaves, heat radiation, light and X-radiation are examples for electromagnetic waves. Many applications require to focus the electromagnetic fields to...

Im Focus: Carbon Nanotubes Turn Electrical Current into Light-emitting Quasi-particles

Strong light-matter coupling in these semiconducting tubes may hold the key to electrically pumped lasers

Light-matter quasi-particles can be generated electrically in semiconducting carbon nanotubes. Material scientists and physicists from Heidelberg University...

Im Focus: Flexible proximity sensor creates smart surfaces

Fraunhofer IPA has developed a proximity sensor made from silicone and carbon nanotubes (CNT) which detects objects and determines their position. The materials and printing process used mean that the sensor is extremely flexible, economical and can be used for large surfaces. Industry and research partners can use and further develop this innovation straight away.

At first glance, the proximity sensor appears to be nothing special: a thin, elastic layer of silicone onto which black square surfaces are printed, but these...

Im Focus: 3-D scanning with water

3-D shape acquisition using water displacement as the shape sensor for the reconstruction of complex objects

A global team of computer scientists and engineers have developed an innovative technique that more completely reconstructs challenging 3D objects. An ancient...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

 
Latest News

New 3-D imaging reveals how human cell nucleus organizes DNA and chromatin of its genome

28.07.2017 | Health and Medicine

Heavy metals in water meet their match

28.07.2017 | Power and Electrical Engineering

Oestrogen regulates pathological changes of bones via bone lining cells

28.07.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>