Nursing home staff do not perceive residents dying with advanced dementia as having a terminal condition, and most of those residents do not receive optimal palliative care, according to newly published research. As a result, management and educational strategies are needed to improve end-of-life care for advanced dementia residents, say authors writing in the Archives of Internal Medicine.
Analyzing data from the Minimum Data Set for 1994 through 1997, researchers studied groups of New York nursing home residents who died within one year of admission and had been diagnosed with either advanced dementia or terminal cancer.
At admission time, just 1.1% of the residents with advanced dementia were thought to have a life expectancy of less than six months, but 71% died within that period. Lab tests (49%), tube feeding (25%), restraints (11%) and intravenous therapy (10%) were among the common non-palliative interventions.
Residents with terminal cancer were more likely to have directives limiting care and less likely to experience “burdensome interventions.” The advanced dementia residents displayed the following “distressing conditions,” study authors observed: pressure ulcers (15%), constipation 914%), pain (12%) and shortness of breath (8%). The lead study author was Dr. Susan Mitchell, of the Harvard Medical School Division on Aging.
