Comments on GeriPal - Geriatrics and Palliative Care Blog: End Stage Dementia: A Terminal Disease Needing P...

Thank you Ken for your comments. I think the bigge...

2009-10-21T09:34:24.638-07:00

Thank you Ken for your comments. I think the biggest hurdle in palliative care is the common thought that this is primarily end of life discussions. I would like to see the emphasis put on managing chronic conditions from their onset and working through them until the end of life. This provides for better understanding of the disease process and its trajectory. I find this helpful especially with the dementia patients.

Like Ken, I appreciated the NY Times coverage of t...

2009-10-20T14:04:40.583-07:00

Like Ken, I appreciated the NY Times coverage of the Mitchell article, especially the comments of Dr. Sachs. From the Well blog attached to the column, one of the bloggers posted a link to an article from the journal, Health Affairs from 2005.

http://content.healthaffairs.org/cgi/content/full/24/4/1064?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=winakur&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

This article is written by a geriatrician and medical director of a skilled nursing unit. I found it to be a complete and full description of the progression of medical "care" received by patients with advanced dementia. Of course, as a palliative care physician, I do not appreciate the end of the article where the author suggests that he might use morphine to shorten his father's life in the end (rather than to treat his pain), but this is a relatively minor point in an otherwise excellent piece. It's long, but very worth the read.

There is an excellent discussion of Dr. Mitchell's...

2009-10-20T11:40:10.356-07:00

There is an excellent discussion of Dr. Mitchell's article and Dr. Sach's editorial in the New York Times by Tara Parker-Pope. (http://www.nytimes.com/2009/10/20/health/20well.html?em)

It includes a nice quote from Dr. Sach's that makes the case for palliative care, and reminds me how important it is to deal with the common myth that palliative care is less "aggressive":

“We’re not talking about aggressive care versus no care,” he said. “Palliative care is aggressive and attentive and focused on symptom management and support of the patient and family. It’s not any less excellent care.”

Also, be sure to check out Parker-Pope's blog:

(http://well.blogs.nytimes.com/2009/10/19/the-wrong-care-for-dementia-patients/)

There are many moving posts from family members who are on the front lines caring for loved ones with advanced dementia. We ought to listen carefully to what they have to say.

Thanks for this nice summary. When I was workin...

2009-10-20T08:47:16.590-07:00

Thanks for this nice summary.

When I was working for a non-profit hospice, we were struggling with many claims denials of these dementia/FTT patients because they were living too long and weren't 'declining.' Articles like this will definitely help strengthen the case that this population needs good palliative care.

Short of changing the hospice benefit, we really need a pre-hospice program for these demented patients who will likely live longer than 6 months but whose families no longer want the revolving door of the hospital. Caregiver support, custodial care, respite (for patients at home) etc.

I think that invariably families are not informed ...

2009-10-19T01:44:24.435-07:00

I think that invariably families are not informed well enough about the physical as well as the mental deterioration that Alzheimers is likely to have on their relative. It is abolsutely correct that care & treamtment in many areas has not moved on in the last 20 years. However, there are many care facilities out their who are using the therapeutic route throughout the Alzheimers journey.