End-of-Life Care in Advanced Dementia

Abstract

In the next 30 years, the average age of the population will continue to increase, as will the prevalence of dementia. The management of advanced dementia requires the careful orchestration of communication, prognostication, patient care, and caregiver education. Understanding the specific tools available to establish prognosis and guide medical management in these complicated medical patients greatly improves patient and caregiver satisfaction at the end of the patient's life. In caring for patients with advanced-stage dementia, providers should be knowledgeable regarding the terminal nature of the condition and its common comorbid diseases, and should be prepared to educate the patients' caregivers, building a structure of support for the patient's benefit and navigating the complexities of end-of-life care.

Accuracy of two prognostic indexes to predict mortality in older adults with advanced dementia

“…However, dementia is known to have a varying and multifaceted disease course, which limits the prognostic capacity of the FAST scale. Therefore, the data do not yet support its use for direct determinations of prognosis, but FAST can function as a criterion within a larger prognostic scale 3 . The Clinical Dementia Rating (CDR) applies to a wide range of mild to more severe stages of dementia, and it is useful when a global assessment of cognitive function is required 30 .…”

“…The grading scale most used to determine prognosis in end-of-life dementia is the FAST, which rates the severity of AD 3,19 . This instrument has limitation because it assumes stepwise disease progression.…”

“…Dementia is the most important and independent cause of disability and mortality in older people living in lowand middle-income countries (LMICs), and almost 66% of people with dementia live in these areas 2 . Alzheimer's disease (AD), the most common etiology of dementia, is the sixth leading cause of death in the United States and the fifth cause of death in individuals aged 65 years or older globally, with a mortality rate similar to cerebrovascular disease 3,4 . People with dementia have an average mortality risk of 2.6 times higher than those in the same age group without dementia, and in LMIC, the mortality rates are 1.6-5.7 times higher when compared to people without dementia 2 .…”

Frontotemporal Dementia

“…Families do not know what to expect in the final stages of FTD, and the need to educate them as well as provide support and guidance in making difficult end-of-life decisions is of paramount importance. 115 When a patient with FTD dies, postmortem brain examination is of great scientific interest to the treating team as well as to family members to ascertain the diagnosis and for genetic counseling to siblings and offspring. 45 Anticipated approval is sought from the family or next of kin in advance and support given to the bereaved family as they decide on performing the autopsy, at the time of death and when postmortem results are available.…”

Comunicação e cuidados paliativos em demência: revisão de 5 anos

“…Palliative Care is defined as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual 7 . Considering that the course of advanced dementia is often erratic, but almost always progressive and that no specific treatment is available, it is consensual that these patients need an end-of-life care approach 9 . In order to succeed in this task, it is indispensable for the health team to take charge of these patients to develop a good communication 10 .…”