Author Affiliations: Department of Medicine, Section of Geriatrics, and MacLean Center for Clinical Medical Ethics, The University of Chicago, Pritzker School of Medicine (Drs Brauner and Sachs) and Department of Hematology Oncology-Palliative Care, Northwestern University Medical School (Dr Muir), Chicago, Ill.
Physicians increasingly are called on to provide primary care for the
growing population of people with Alzheimer-type dementia. However, little
attention has been paid to the care of nondementia illnesses in this group
of patients. To illustrate how presence of dementia can alter the risk-benefit
ratio of treatment of a common medical problem, we present a case study in
which a patient with dementia developed disastrous adverse effects to a drug
commonly used to treat osteoporosis. This case and 2 composite vignettes illuminate
how presence of dementia should influence the decision-making process for
treatment of nondementia illnesses. We address issues such as decreased decision-making
capacity, problems with reporting adverse effects, decreased cognition leading
to problems with treatment adherence, and the role of screening and basic
questions about acceptable burdens of treatments in patients with limited
prognosis. We suggest ways to improve communication with patients with dementia
in an effort to minimize complications and improve care, as well as policy
changes to include patients with dementia in clinical trials.
Brauner DJ, Muir JC, Sachs GA. Treating Nondementia Illnesses in Patients With Dementia. JAMA. 2000;283(24):3230–3235. doi:10.1001/jama.283.24.3230
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