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Dementia Care at End of Life: Current Approaches

Abstract

Purpose of Review

Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia.

Recent Findings

Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia.

Summary

Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.

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Fig. 1

Abbreviations

ACP:

Advanced care planning

AD:

Alzheimer disease

ADEPT:

Advanced Dementia Prognostic Tool

BPSD:

Behavioral and psychological symptoms of dementia

CASCADE:

Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life

CBT:

Cognitive behavioral therapy

DICE:

Describe, Investigate, Create, and Evaluate

EOL:

End of life

FAST:

Functional Assessment Staging Tool

HR:

Hazard ratio

ICU:

Intensive care unit

NHPCO:

National Hospice and Palliative Care Organization

NPS:

Neuropsychiatric symptoms

SPREAD:

Study of Pathogen Resistance and Exposure to Antimicrobials in Dementia

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Correspondence to Maria I. Lapid.

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Bartley, M.M., Suarez, L., Shafi, R.M.A. et al. Dementia Care at End of Life: Current Approaches. Curr Psychiatry Rep 20, 50 (2018). https://doi.org/10.1007/s11920-018-0915-x

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Keywords

  • Advanced care planning
  • Hospice
  • Late-stage dementia
  • Palliative care
  • Prognostication