Author Affiliations: Center for Excellence in Nursing Practice, Brigham and Women's Hospital, the School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, Mass (Dr Hurley); and Geriatric Research Education Clinical Center, Edith Nourse Rogers Memorial Veterans Medical Center, Bedford, Mass, and Boston University Medical School, Boston, Mass (Dr Volicer).
Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
About 4 million people in the United States have Alzheimer disease (AD)
and the number of incident cases is expected to more than double from 377 000
in 1995 to 959 000 in 2050. Patients, their families, and health care
professionals struggle with a relentless and irreversible neurological syndrome
that can last from 2 to 20 years. Alzheimer disease causes both cognitive
and functional impairments that predispose the patient to behavioral symptoms,
destroy intellectual capacity and personality, erase the ability to communicate
one's wishes for care, and lead to life-threatening consequences. At the close
of life, family members and clinicians face decisions regarding degrees of
intensive medical care to be provided for treatment of the late-stage consequences
of AD, including withdrawal of invasive interventions, initiation of hospice,
and treatment of a range of progressive medical conditions. Physicians can
assist patients with AD and their loved ones through the terminal phases of
the illness by preparing them for the relentless progression of the disease
and by supporting them through the intellectual and emotional conflicts accompanying
the end of life.
Hurley AC, Volicer L. Alzheimer Disease"It's Okay, Mama, If You Want to Go, It's Okay". JAMA. 2002;288(18):2324-2331. doi:10.1001/jama.288.18.2324