End-of-Life Care Decisions for Patients with Dementia

Written by Mary Dioise Ramos, Judith Hold, & Rita Mahmoud

doi: https://doi.org/10.13178/jnparr.2021.11.01.1008

Abstract

Introduction: An estimated 50 million people worldwide live with dementia and nearly 10 million new cases every year have been reported. As a chronic illness, dementia involves the gradual loss of cognitive functions and behavioral abilities. As people with dementia reach end-of-life, planning for future medical care is of utmost importance as they face this life-limiting condition.

Clinical Goal/Clinical Problem: In this case report, the end-of-life disease trajectory, advance care planning, decision-making, and ethical considerations of a person living with advanced dementia are explored.

Assessment: The clinical triggers in the case are the progression of the disease, advance care planning, and surrogate decision making.

Implementation: Recognizing deteriorating conditions, assessing the patient’s end-of-life wishes and the surrogate decision maker’s knowledge about the disease, and communication with patients and families about treatment choices are necessary to improve end-of-life care for a person with dementia coupled with the need to overcome ethical challenges influencing the preservation of one’s autonomy, respect, and dignity.

Evaluation and Discussion: Early and ongoing conversations are necessary between patients, families, and healthcare professionals to ascertain preferences for end-of-life care.

Keywords: caregiver, dementia, end-of-life care, decision-making, advance care planning