Doctors Ignore Dementia in Terminal Alzheimer Patients

Seriously ill Alzheimer’s patients with end-stage dementia are not receiving appropriate treatment, according to a new study. The findings also show that doctors ignore the dementia as an illness and continue with invasive procedures for other health problems instead of focusing on making their patients more comfortable.

Published in the latest issue of the Journal of the American Medical Association, the study concluded that doctors should place more emphasis on easing the discomfort and pain of terminal patients with dementia than on trying to cure other health problems such as pneumonia or hip fractures.

The study of 216 patients aged 70 or older was conducted over a period of 18 months. Researchers compared one group of patients hospitalized with hip fractures or pneumonia with another group who were also diagnosed with end-stage dementia. Both groups were given the same level of invasive treatments such as blood tests, X-rays and catheters. The startling conclusion found that those who also suffered from dementia were at least four times more likely to die within six months.

An estimated 1.8 million people in the United States are in the final stages of a dementia-type illness such as Alzheimer’s disease. Patients are usually unable to recognize family, care for themselves, or communicate well. This study raises important questions about whether aggressive care should be provided for patients with dementia. “Patients with dementia with a greater than 50% likelihood of dying are unlikely to gain as much benefit from daily phlebotomy as do their cognitively intact counterparts, for whom cure may mean many more years of fully functional life,” commented Don Reisenberg, MD, in the Journal’s editorial.

Dr R. Sean Morrison, lead author of the study, recommended that “burdensome hospital treatments be carefully evaluated” for patients who have a “very limited prognosis.” The researchers also pointed out the need for the family to spend time discussing their relative’s health care preferences and to record them in a document called an Advance Directive, which lists out certain medical procedures to avoid in times of crisis.

Source: Journal of American Medical Association

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