E. L. is an 88-year-old widow who has advanced dementia. She is a retired secretary and is cared for in the home of her divorced daughter, who is her power of attorney for health affairs.
Topic: Knowledge assignment 8
E. L. is an 88-year-old widow who has advanced dementia. She is a retired secretary and is cared for in the home of her divorced daughter, who is her power of attorney for health affairs. E. L. requires assistance with all activities of daily living. She spends most of the day sitting in her orthopedic recliner (she has had bilateral hip replacements) or lying in bed. She does not speak or acknowledge the presence of others.
Recently, E. L. has stopped eating all meals except for small banana slices. She resists a spoon when it is brought to her mouth, and she pockets food in her cheeks without swallowing. E. L. was admitted to the hospital several months ago for influenza and bilateral pneumonia. She was treated in the intensive care unit for three days and then sent home.
The possibility of a feeding tube insertion was discussed during her hospitalization. E. L.’s daughter is seeking guidance on artificial nutrition and hydration.
Use the assigned readings to guide you in the development of five discussion points.
Discussions points should reflect best practices that you will include as you speak with E. L.’s daughter regarding her mother’s end-of-life care.
Cite your references in proper APA Style.
Review the rubric for more information on how your assignment will be graded.
Please make sure to include all the points and refer to the scenario. Thank you in advance.
To answer frequently asked questions about management of end-stage pneumonia, poor nutritional intake, and dehydration in advanced dementia.
Ovid MEDLINE was searched for relevant articles published until February 2015. No level I studies were identified; most articles provided level III evidence. The symptom management suggestions are partially based on recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia.
Feeding tubes are not recommended for patients with end-stage dementia. Comfort feeding by hand is preferable. Use of parenteral hydration might be helpful but can also contribute to discomfort at the end of life.
Withholding or withdrawing artificial nutrition and hydration is generally not associated with manifestations of discomfort if mouth care is adequate. Because pneumonia usually causes considerable discomfort, clinicians should pay attention to symptom control. Sedation for agitation is often useful in patients with dementia in the terminal phase.
Symptomatic care is an appropriate option for end-stage manifestations of advanced dementia. The proposed symptom management guidelines are based on a literature review and expert consensus.
I introduced Mrs M., an 85-year-old woman with advanced dementia, in part 1 (page 330) of this 2-part review about end-of-life issues in advanced dementia, in which I discussed goals of care, the decision-making process, and how to educate families about therapeutic options. In this article, I will focus on symptom management and care issues at the end of life. Recurrent infections and poor nutritional intake are hallmarks of advanced dementia.
The appropriate use of antibiotics and artificial nutrition and hydration (ANH) poses many clinical and ethical challenges for the treating physician.
You and Mrs M.’s daughter have discussed the therapeutic options for Mrs M.’s probable end-stage pneumonia. She agrees that symptomatic care is the most appropriate option at this stage. However, she worries about the pain or discomfort her mother might experience from dehydration and starvation, as well as her pneumonia.
This article is based on a review of literature about end-of-life care in advanced dementia. MEDLINE was searched for articles published until February 2015, containing the following MeSH terms: dementia and palliative care or terminal care; and dementia and pneumonia. A total of 41 articles were retrieved.
The search was supplemented with review of related topics in the UpToDate database (www.uptodate.com).
The guidelines for the management of symptoms are also based on my recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia.