Dementia is a grave cognitive disorder. It apparently results in long-term deterioration in cognitive function due to damage or disease in the body further than what might be anticipated from usual aging. The clinical course of advanced dementia, plus uncomfortable symptoms like soreness and high mortality, is apparently alike to that suffered by patients of other fatal conditions, as per experts at the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School.
It is claimed to be the first study to meticulously explain the clinical course of advanced dementia, one of the top causes of death in the United States. Preceding studies propose that patients with advanced dementia are apparently under-recognized as being at high danger of death and receive suboptimal palliative care, which supposedly intends to enhance the comfort of fatally ill patients.
“Dementia is a terminal illness. As the end of life approaches, the pattern in which patients with advanced dementia experience distressing symptoms is similar to patients dying of more commonly recognized terminal conditions, such as cancer,” commented lead author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research,
The study emphasizes the requirement to develop the superiority of palliative care in nursing homes to supposedly decrease the physical suffering of patients with advanced dementia, and to enhance interaction with their family members.
Dr. Mitchell mentioned, “This will help to ensure that patients and families understand what to expect in advanced dementia, so that appropriate advance care plans can be made.”
The ‘Choices, Attitudes and Strategies for Care of Advanced Dementia at the End-of-Life,’ or CASCADE, study trailed the clinical course of around 323 nursing home residents with advanced dementia living in 22 Boston-area nursing homes for about 18 months. At the last stage of the disease, patients had intense memory discrepancies like they could not identify close family members, spoke lesser than six words, and were nonambulatory and incontinent.
Around 177 patients died during the course of the study. The experts discovered that the most general complications were pneumonia, fevers and eating problems, and that these complications were linked to high six-month mortality rates. Symptoms like pain, pressure ulcers, shortness of breath, and aspiration, were also common and apparently increased as the end of life came closer.
Dr. Mitchell, an Associate Professor of Medicine at Harvard Medical School, mentioned that she and her team discovered that while around 96 percent of the patients’ health-care proxies were of the opinion that comfort care was the main objective of care for their loved one, almost 41 percent of patients who died during the study went through at least one intervention, including hospitalization, an emergency room visit, intravenous therapy, or tube feeding, in the last three months of life. Nevertheless, patients whose health-care proxies supposedly understood that the clinical course of the disease were less expected to be given aggressive treatment near the end of life.
Dr. Mitchell quoted, “Many of the patients in our study underwent interventions of questionable benefit in the last three months of life. However, when their health-care proxies were aware of the poor prognosis and expected clinical complications in advanced dementia, patients were less likely to undergo these interventions and more likely to receive palliative care in their final days of life.”
Dr. Mitchell added, “A better understanding of the clinical trajectory of end-stage dementia is a critical step toward improving the care of patients with this condition. This knowledge will help to give health-care providers, patients and families more realistic expectations about what they will confront as the disease progresses and the end of life approaches.”
At the starting of the study, about 81 percent of the proxies felt they understood which clinical complications to anticipate in advanced dementia, yet only roughly one third mentioned that a physician had advised them about these complications. At present, more than 5 million Americans suffer from dementia, a figure that is likely to amplify nearly three-fold in the next 40 years. A recent study by Alzheimer’s Disease International estimates that the amount of people with dementia all over the world could surpass 35 million by 2050.
This study was published in The New England Journal of Medicine.