Realistic Hopes for Dementia Patients

A study published in last week's New England Journal of Medicine questions whether nursing homes too often send Medicare patients with advanced Alzheimer's disease or other dementias to the hospital near the end of their lives.  The following opinion piece was published in yesterday's Battle Creek Enquirer.

Advanced dementia is a terminal condition, yet often family members who have watched their loved one slowly fade over a period of months or years cannot come to grips with the fact that they are dying. They want "everything possible" done to help their relative, even when it means subjecting them to surgery and other procedures that may keep them alive but increase their pain and discomfort.

When family members, against all odds and advice, refuse to give up "hope" that the patient will "recover," a skilled care facility is obligated to cooperate with their wishes, including hospitalization that in no way will enhance the patient's quality of life.  It is this very expensive and usually futile care delivered near the end of life that not only can prolong a person's suffering, but also is a major contributor to soaring health-care costs.

While economic greed may contribute to the problem of needless hospitalizations from nursing homes, more often families' unrealistic expectations and demands are the deciding factor.  Yet medical professionals, clergy, politicians and others are loathe to address the issue, lest they be accused of "rationing" care or being "heartless" to the needs of the aged.  At some point a nationwide discussion of the issue must take place.

To bring cost into a discussion of end-of-life care makes most of us very uncomfortable. We don't want to attach a price tag to dying. But terminal care raises both emotional and economic issues. It is as cruel to keep an incapacitated elderly person clinging to life by a thread as it is costly.  We must be realistic in our hopes for our loved ones, and accepting when their journey here on Earth is coming to an end. Otherwise we risk paying an exorbitant price both in human misery and health-care costs.