Late-Dementia Suffering Often Unnecessary
Death Rate for Advanced Dementia Similar to Some End-Stage Cancers
WebMD News Archive
Oct. 14, 2009 -- Patients with advanced Alzheimer’s disease or other
age-related dementias often suffer unnecessarily near the end of life probably
because their condition is not recognized as fatal, researchers say.
The death rate among patients with advanced dementia in a newly published
study was similar to that of patients with end-stage breast cancer or heart
disease, lead researcher Susan L. Mitchell, MD, of Harvard Medical School’s
Institute for Aging Research, tells WebMD.
One in four patients died within six months of recruitment, and slightly
more than half died within 18 months.
Yet in their last months of life, Mitchell says far too many patients
received burdensome medical treatments and far too few received adequate
palliative treatments for pain and other common symptoms, such as shortness of
breath and agitation.
The study appears in the April 15 issue of the New England Journal of
Pneumonia, Fever, Eating Problems Common
Pneumonia, fever, and an eating problem were the most common complications
in the final months of life, and 41% of patients had at least one aggressive
treatment including hospitalization, a visit to the ER, intravenous treatment,
or a feeding tube.
“There is a lack of recognition that dementia is a terminal illness and this
has a big impact on the quality of care patients receive,” Mitchell says. “We
found that a high percentage of patients had distressing symptoms toward the
end of life.”
More than 5 million Americans suffer from Alzheimer’s dementia, and this
figure is expected to triple over the next four decades as baby boomers reach
old age. Alzheimer’s is the most common cause of dementia.
In the late stages of the disease, patients are often bedridden and can no
longer communicate their needs, recognize close family members, or perform
basic functions like feeding themselves and going to the bathroom.
In an editorial published with the study, geriatrician and dementia
researcher Greg A. Sachs, MD, of the Indiana University Center for Aging
Research, recalls his maternal grandmother’s struggle with advanced Alzheimer’s
Her final months in a nursing home included repeated courses of antibiotics
for infections and restraints to control her agitation. Her condition so
distressed Sachs’ mother that she stopped taking her children when she
“My grandmother had little in the way of either comfort or company toward
the end,” he writes, adding that 30 years later, end-of-life care for dementia
“doesn’t look all that different from the treatment she received.”
Pain, Shortness of Breath, Agitation Also Common
The Harvard study included 323 residents with advanced dementia living in 22
Boston-area nursing homes. Researchers followed the patients for up to 18
months and surveyed family members about their understanding of their loved
one’s prognosis and expected complications.