Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Dying from dementia
New England Journal of Medicine editorial
advocates for palliative care
INDIANAPOLIS – A growing number of older
adults are dying from dementia.
In an editorial in the October 15, 2009
issue of the New
England Journal of Medicine, Greg Sachs,
M.D., professor of medicine and director of
the Division of General Internal Medicine
and Geriatrics at the Indiana University
School of Medicine and a Regenstrief
Institute investigator, notes that
end-of-life care for most older adults with
dementia has not changed in decades and
urges that these individuals be provided far
greater access to palliative care, the
management of pain and other symptoms.
Dr. Sachs believes that more research on
palliative care for patients with dementia
is needed to update public policy and get
lawmakers and insurance companies to
recognize the need to support and fund care
which will improve the overall health of
older adults who can no longer speak for
themselves.
"Since individuals with advanced dementia
cannot report their symptoms, these symptoms
often are untreated, leaving them vulnerable
to pain, difficulty breathing and various
other conditions. We shouldn't allow these
people to suffer.
"We
should be providing palliative care to make
them more comfortable in the time they have
left," said Dr. Sachs, who is a geriatrician
and medical ethicist.
While it is not easy, caregivers and medical
personnel should attempt to pick up on
nonverbal clues of pain, such as the
individual holding the body in a certain way
to avoid a painful posture, or exhibiting
swollen, tender joints, he said.
These observations, reported by a caregiver
or found on medical examination, may help
the physician make the patient more
comfortable, and help identify underlying
conditions.
Palliative care involves a team-oriented
approach to pain management and medical
treatment, as well as emotional support
tailored to the patient's needs.
Palliative care focuses on relieving
symptoms such as pain, shortness of breath,
fatigue, nausea, loss of appetite and
difficulty sleeping. Hospice care provides
palliative care but palliative care can be
administered regardless of prognosis along
with medical treatment and does not hasten
death.
Dr. Sachs' editorial accompanies a Harvard
University observational study of 323
patients with advanced dementia residing in
22 nursing homes which found that while few
suffered a sentinel event such as a stroke
or a heart attack, the survival of patients
with advanced dementia was usually less than
a year, especially following the occurrence
of pneumonia, episodes of fever, or eating
problems.
###
Dr. Sachs leads the Indiana Palliative
Excellence in Alzheimer Care Efforts
(IN-PEACE) Program which is studying the
feasibility of incorporating an outpatient
palliative care program for patients with
dementia into the primary care setting,
where most older adults receive their
medical care. The program, supported by a
grant from the National Palliative Care
Research Center, provides improved symptom
management, enhanced family support, and
assistance with difficult decision making.
... ..
...
...