National dementia care guidelines fall far short on ethics issues, researchers find

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Chance of a senior developing Alzheimer's has dropped 44% over the last 30 years
Chance of a senior developing Alzheimer's has dropped 44% over the last 30 years

National clinical practice guidelines for dementia care frequently fail to address important ethical issues, according to newly published research. More than half of U.S. nursing home residents are believed to suffer from some kind of dementia or memory impairment.

Germany-based researchers analyzed the national dementia care guidelines of 12 nations, including the United States. Out of 31 ethical issues identified by the research team, the national guidelines addressed, on average, fewer than half.

The U.S. guidelines, from the American Psychiatric Association, do not address the following ethical issues, the researchers found:

  • Tube feeding
  • Covert medication (e.g. balancing short-term medical benefits vs. long-term impact on patient–physician relationship)
  • Usage of GPS and other monitoring techniques
  • Caring for clinical personnel and professional carers (e.g. needs of professionals; preventing distress and burn out)
  • Adequate consideration of existing advance directives in medical decision making

The APA guidelines are fairly typical in what they do not address. Out of all the guidelines studied, 11 of 12 did not address covert medication, GPS and adequate consideration of advanced directives. 

Scotland's national guidelines ranked lowest, implicitly or explicitly addressing only 35% of ethical issues examined, while the United Kingdom as a whole ranked highest, addressing 91%. However, the United States scored highest with regard to recommendations on how to handle ethical issues, at 71%. Switzerland scored lowest in that group, at 10%.

Click here to access the complete study, published online in PLOS Medicine.