On November 13, 2002,1 Ann C. Hurley,
RN, DNSc, and Ladislav Volicer, MD, PhD, introduced Mrs R, an 80-year-old
African American woman with a long history of diabetes, who had been diagnosed
with Alzheimer disease (AD) at age 71 years. Through interviews with her daughter,
Ms P, and her physician, Dr C, a picture of Mrs R emerged, as a formerly vital
person who had been ravaged by the unremitting course of her disease, such
that by 7 years after she was diagnosed as having AD she was almost entirely
bed-bound in a skilled nursing facility, with severe flexion contractures
of all her extremities and a feeding tube. She was described as having "no
purposeful responses of any kind." Her daughters visited her regularly and
were very attentive to her care, but they had expressed dismay at her condition.
After much struggle and discussion, the difficult decision was made to place
Mrs R in a county-run hospice facility.
Markowitz AJ, Rabow MW. Alzheimer Disease: "It's Okay, Mama, If You Want to Go, It's Okay". JAMA. 2003;290(1):105. doi:10.1001/jama.290.1.105