Dementia is a leading cause of death in the United States, but many people do not realize that dementia is a terminal illness. Now, research published in the October 15, 2009 issue of the New England Journal of Medicine provides additional insight into the clinical course of nursing home residents with advanced dementia.

Researchers from the Hebrew SeniorLife Institute for Aging Research and their colleagues identified 323 nursing home residents with advanced dementia from 22 nursing homes and followed them for 18 months. During this follow-up period, 54.8% of the residents with dementia passed away. The researchers found that pneumonia, fevers, and eating problems were frequent complications in patients with advanced dementia. Further, they found that these complications were associated with high 6-month mortality rates. Nursing home residents with dementia were also likely to experience distressing symptoms, including shortness of breath and pain. And, in the last 3 months of life, over 40% of nursing home residents with dementia underwent at least one medical intervention, such as hospitalization, an emergency room visit, or tube feeding.

The researchers found that those nursing home residents who had health care proxies with an understanding of the poor prognosis expected in advanced dementia were far less likely to have burdensome interventions in the last 3 months of life. The findings of this study underscore the importance of educating family members on the potential complications and poor prognosis associated with advanced dementia so that they can make informed decisions about palliative care and avoid unnecessarily aggressive medical interventions toward the end of life.

Source:

NEJM. 2009;361:1529-1538.