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End-of-life care and dementia

Published online by Cambridge University Press:  03 July 2006

Louise Robinson
Affiliation:
Centre for Health Services Research, University of Newcastle-upon-Tyne, UK
Julian Hughes
Affiliation:
North Tyneside General Hospital, Tyne & Wear, UK
Sarah Daley
Affiliation:
North Tyneside General Hospital, Tyne & Wear, UK
John Keady
Affiliation:
School of Health, Community and Education Studies, Northumbria University, UK
Clive Ballard
Affiliation:
Wolfson Centre for Age-Related Disorders, Kings College, London, UK
Ladislav Volicer
Affiliation:
School of Aging Studies, University of South Florida, Tampa, USA

Extract

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.

Type
Neuropsychiatry of old age
Copyright
© 2006 Cambridge University Press

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