Hospice use for the patient with Advanced Alzheimer's Disease

FROM THE AMERICAN JOURNAL OF ALZHEIMER'S DISEASE:

Alzheimer's disease (AD) places incredible amounts of stress on the caregiver. Because of the disease's progressive decline, the burden of this illness is already greater than that of diabetes and equal to that of breast cancer in the United States. While depression and anxiety are common during the earlier stages of AD, agitation becomes a more prominent symptom in the later stages of the disease. The management of this agitation becomes increasingly difficult for both caregivers and healthcare providers, particularly as the patients lose their ability to verbalize the source of their discomfort. Thus, it becomes necessary for physicians to build a framework in advance for handling the needs of the end-stage AD patient.

End of Life (EOL) care options should include symptom management of physical and behavioral issues. The focus in EOL/Palliative care is pain assessment and management; physical, psychological, social and spiritual care to both the patient and their family. Palliative care seeks to avoid unnecessary acute care that may prolong the death process, seeks to reduce uncomfortable symptoms and ensures the patient a comfortable, natural death.

Pain assessment in the dementia patient can be difficult for physicians and caregivers as the advanced AD patient may lack the ability to properly express their needs due to cognitive loss and limited recall. Recent studies show that cognitively impaired patients with hip fractures received significantly less pain medication than cognitively intact patients with the same medical condition.

Restorative care is an extremely common approach used to manage patients with end-stage dementia. There are many studies, though, that suggest that restorative care is not the best approach to caring for end-stage dementia and, in fact, some restorative care approaches actually cause more stress, anxiety, pain and mental decline than if the family chose to use palliative care approaches. These studies further show that aggressive measures to cure infections and prolong life can actually result in extension of the patient's pain and suffering while not increasing life expectancy. However, it is understandable that families often have difficulty in making the decision to forego medical treatment.

Hospice is committed to maintaining the quality of life for the dementia patient. Unfortunately, the majority of families and physicians are not familiar with Hospice and even fewer are aware that it can be used for advanced dementia. Dementia patients require comprehensive care throughout the course of the disease. The physician must provide three areas of treatment for the patient and their family:

> Treating the cognitive deterioration and the behavioral complications of the disease.

> Educating the patient's family about the disease and monitoring the burden of caring for a dementia patient.

> Planning future care for the AD patient in a collaborative fashion. Palliative care options are an integral part of the future planning discussions on the part of the physician.

The decision of how to manage end of life care is extremely difficult, and patients and families need time to come to that decision based upon their own sets of values and beliefs. Without enough time for proper discussion, the decision may ultimately lead to disagreements between family members and a poor quality of life for the patient. When Hospice is working with the physician and family regarding EOL care, they can be assured that Hospice is delivering the type of care and services needed in accordance with the wishes of the family.

For more information regarding the Health Care Coverage for Hospice, conditions and flexibility of the services or to inquire about other eligibility factors, please contact Hospice of Buffalo, New York at (716)626-8040.

For information regarding ElderWood Senior Care, please contact us at (716) 633-3900.