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Perspectives on Care at the Close of Life: CODA
July 2, 2003

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

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.

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