Magazine article Clinical Psychiatry News

Advanced Dementia Not Seen as Terminal: Nursing Home Residents

Magazine article Clinical Psychiatry News

Advanced Dementia Not Seen as Terminal: Nursing Home Residents

Article excerpt

BALTIMORE -- Patients with advanced dementia are generally not recognized as having a terminal condition and may not receive palliative care until death is perceived as imminent, Dr. Susan L. Mitchell said at the annual meeting of the American Geriatrics Society.

Dr. Mitchell and her colleagues at Harvard Medical School, Boston, compared the end-of-life experiences of 1,609 nursing home residents with advanced dementia with the experiences of 883 residents with terminal cancer. All of the residents died within 1 year of admission at any of New York state's 643 nursing homes in 1994-1997.

Residents with advanced dementia were significantly less likely to have care directives that limited aggressive care (do-not-resuscitate or do-not-hospitalize orders) but were more likely to have nonpalliative interventions (tube feeding, laboratory tests, and restraints). The results were adjusted for age, gender, functional status, ethnicity, length of stay, and the number of days since the last Home and Community Care Minimum Data Set assessment. …

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