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Study Casts Doubt on Hospice Admission Criteria for Patients With Dementia
Date:11/2/2010

By Serena Gordon
HealthDay Reporter

TUESDAY, Nov. 2 (HealthDay News) -- Many people with advanced dementia aren't getting much-needed hospice care because the admission criteria is flawed, researchers say.

"Dementia is a leading cause of death in the U.S., and hospice care can benefit patients with dementia. The main hindrance to getting palliative [comfort] care is guidelines that try to guide practitioners to wait until an estimated life expectancy of six months," said Dr. Susan L. Mitchell, a senior scientist at the Institute for Aging Research at Hebrew SeniorLife in Boston, and lead author of a new study.

Such end-of-life predictions are difficult to make with certainty in dementia cases. Instead of using life expectancy as the requirement for admission, hospice care for dementia patients should be offered based on the patient's and family's desire for comfort care, suggest Mitchell and colleagues in the study published in the Nov. 3 issue of the Journal of the American Medical Association.

Hospice, or palliative, care is most often associated with cancer patients. The goal is to provide comfort and support to patients and their families, instead of life-prolonging treatments.

For people with cancer, the decision to switch to palliative care is more clear-cut. It generally occurs when someone decides to forgo traditional cancer treatments, such as chemotherapy or radiation, that don't seem to be working anymore, and instead receive comfort care, which includes better pain management and discussions about important end-of-life care decisions.

For people with dementia, the decision process is murkier. Most people with advanced dementia are already in nursing homes, receiving around-the-clock care, but palliative care can provide families with additional support and help families make difficult decisions, such as whether or not to treat infections with antibiotics or to use a feeding tube
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