Nearly 14 years ago, Volicer et al1 described
an early model of hospice care for patients with advanced Alzheimer disease.
In that study, although physicians had a difficult time estimating survival,
they successfully emphasized comfort care and documented explicit decisions
regarding withholding interventions.
The justification for that model of care is that irreversible dementia
is a terminal illness and that patients and caregivers should be given an
early opportunity to decide about intensity of care before the disease inevitably
progresses. It appears from the article by Morrison and Siu2
in this issue of THE JOURNAL that this concept has yet to gain acceptance,
at least at 1 hospital at an academic center with a well-established department
of geriatric medicine.
Riesenberg D. Hospital Care of Patients With Dementia. JAMA. 2000;284(1):87-89. doi:10.1001/jama.284.1.87