Making Tough Decisions about End-of-Life Care in Dementia by Anne Kenny

Author:Anne Kenny
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2017-01-18T16:00:00+00:00

PREVENTIVE AND DISEASE-MODIFYING TREATMENTS FOR OTHER CHRONIC DISEASES

USING WELL-BEING AS A GUIDE TO TESTING AND INTERVENTIONS IN LATE-STAGE DEMENTIA

• The Jensen Family Story •

Mr. Jensen moved to a facility after two months of bouncing back and forth between the hospital and rehabilitation sites. His frail wife and three devoted children, Laurie, Anna, and Oliver, had been sitting with him, often day and night, during these past months. They tried to assist, comfort, and calm him, as each transition wreaked havoc on his mental state. Laurie described her father’s cognitive condition over the last year, knowing that we were currently dealing with delirium while I hoped to gauge his prior stage of dementia.

In the 10 months leading up to his repeated hospitalizations, he had been losing the ability to speak, sleeping more, and interacting less. He had begun to lose weight, not because of swallowing difficulty, but because he slept through most meals and wasn’t interested in food when it was offered. Her father had two known cancers, both in quiet states, but enlarged lymph nodes recently found in his abdomen were suggestive of a new cancer. The family had chosen not to further evaluate the nodes because “my dad is so old, his thinking is already off and these hospitalizations are so hard on him.” We talked further so I could understand how the family felt about medical interventions, in light of the advancing dementia and possible third cancer. Laurie wanted to learn more about dementia. We discussed that dementia is a terminal disease but, much like cancer, can have a long period of chronicity in which life is lived well, with some adaptation but reasonable function. Also similar to cancer, when dementia progresses further with more prevalent signs and symptoms, letting go of medical interventions may be the best way to live life well and allow for a natural death.

Laurie, using her father’s cancers to guide her thinking, acknowledged that her father’s dementia had advanced, but she wasn’t sure to what degree. Although we would work on addressing the delirium, the family could still decide to limit their father’s care once his stage of dementia was better defined. “We’ve all been grappling with doing too much or too little. It is comforting to know that we may not know. It is also comforting to know one decision can be made now and others can be considered later. I’ve been so caught up in having answers, I failed to see that not knowing was OK.”

The continued treatment of chronic disease states and prevention of disease is an often asked question when dementia is approached from a palliative lens. Many family members and sometimes even physicians ask why I bother “upsetting the apple cart.” The number and type of medications often used with advancing age and near end of life can be quite burdensome. With dementia, this burden increases even more. Every medication carries the risk of drug-drug interactions, and any medication or intervention has potential adverse reactions. Just administering—and taking—medications can be troublesome.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.