Received from the Department of Medicine (GAS, JWS, DCH), Section of Geriatrics, The University of Chicago, Chicago, Ill.
Barriers to Excellent End-of-life Care for Patients with Dementia
Article first published online: 11 OCT 2004
Journal of General Internal Medicine
Volume 19, Issue 10, pages 1057–1063, October 2004
How to Cite
Sachs, G. A., Shega, J. W. and Cox-Hayley, D. (2004), Barriers to Excellent End-of-life Care for Patients with Dementia. Journal of General Internal Medicine, 19: 1057–1063. doi: 10.1111/j.1525-1497.2004.30329.x
- Issue published online: 11 OCT 2004
- Article first published online: 11 OCT 2004
- palliative care;
- end-of-life care;
- Alzheimer's disease;
While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; assessment and management of symptoms; the caregiver experience and bereavement; and health systems issues. We suggest approaches for overcoming these barriers in the domains of education, clinical practice, and public policy. As the population ages, general internists increasingly will be called upon to provide primary care for a growing number of patients dying with dementia. There are great opportunities to improve end-of-life care for this vulnerable and underserved population.