End‐of‐Life Decisions in Individuals Dying with Dementia in Belgium

Abstract

End-of-life decision-making in individuals dying with dementia differs from that in individuals with cancer, more often involving forgoing of life-prolonging treatment and less often involving intensifying pain and symptom treatment. Considerations typically involve the prospects of the individual with dementia as opposed to the severity of their present situation. Optimal processes of advance care planning may address the burdensome decision falling to physicians and family regarding when to allow the individual to die.

Aggressiveness of End‐of‐Life Care for Hospitalized Individuals with Cancer with and without Dementia: A Nationwide Matched‐Cohort Study in France

“…Few studies have investigated how the diagnosis of dementia affects the receipt of aggressive end‐of‐life care in older adults . The preferences of individuals with dementia have been found to be for a less‐aggressive approach near the end of life, but evidence to assess whether these differences in individual preferences result in lower rates of aggressive care in the final months before death is lacking.…”

“…13 Few studies have investigated how the diagnosis of dementia affects the receipt of aggressive end-of-life care in older adults. [14][15][16] The preferences of individuals with dementia have been found to be for a less-aggressive approach near the end of life, 17,18 but evidence to assess whether these differences in individual preferences result in lower rates of aggressive care in the final months before death is lacking. Using a matched cohort study design, the goal of the current study was to compare the aggressiveness of end-of-life care in hospitalized individuals with cancer with and without dementia in France.…”

Changes in Care Goals and Treatment Orders Around the Occurrence of Health Problems and Hospital Transfers in Dementia: A Prospective Study

“…Dementia is a disease without a cure, and one of the key components of the quality of palliative care for patients with dementia is advance care planning . Advance care planning is especially important for people with dementia because the gradual loss of cognitive abilities complicates decision making at the end of life . In the last phase of life, the majority of people with dementia in the United States and Western Europe are admitted to and eventually die in long‐term care facilities .…”

“…[1][2][3] Advance care planning is especially important for people with dementia because the gradual loss of cognitive abilities complicates decision making at the end of life. 1,[4][5][6] In the last phase of life, the majority of people with dementia in the United States and Western Europe are admitted to and eventually die in long-term care facilities. 7 Advance care planning in long-term care in dementia concerns timely and ongoing discussions about care goals, and part of this is communication about end-of-life issues.…”

Bioethical implications of end-of-life decision-making in patients with dementia: a tale of two societies

“…While in Belgium, Chambaere et al report that the end-of-life decision is typically made without the patient's input (i.e. only 1.2% to 6.7% of patients with dementia are involved in the decision making process in cases of euthanasia), involving only the physician and the long-term family caregivers in the decision-making process (Chambaere et al 2015). Furthermore, the decision to hospitalize nursing home patients with dementia in Belgium follow the physician's orders and not an AED (Houttekier et al 2014).…”