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Hospice care good for nursing home residents with advanced dementia

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David Liu and editing by Denise Reynolds

Life is not easy for elderly people with advanced dementia like Alzheimer's who reside in a nursing home.  If there are not many days left for them, they may better off being referred to hospice, a new study suggests.

The study led by DK Kiely and colleagues of Hebrew SeniorLife Institute for Aging Research in Boston, Massachusetts found hospice recipients were more likely to regularly receive opioids for pain and treatments for symptomatic dyspnea.  They also had fewer unmet needs at the end of their life.

Kiely et al. followed 323 nursing home residents with advanced dementia and their healthcare proxies for up to 18 months to collect data on hospice referral, frequency of pain, dyspnea and their treatments, and unmet needs for the last seven days of the residents' lives.

During the follow-up, 26 percent of the nursing home residents were referred to hospice.  Factors associated with hospice referral included nonwhite race, eating problems, proxies' perception that the residents had fewer than 6 months to live, and better proxies' mental health.

The researchers found residents in hospice were more likely to be treated with opioids for pain regularly and with oxygen, morphine, scopolamine, or hyoscyamine for dyspnea. Healthcare proxies in hospice reported fewer unmet needs during the last days of the residents' lives.

The study was reported in the Dec 2010 issue of Journal of American geriatrics Society.

Dementia like Alzheimer's disease is a disabling illness. Healthy aging should not result in dementia.  Alzheimer's disease, which as a major form of dementia, has no cure and affects 4 to 5 million Americans, according to nih.gov.

Studies suggest Mediterranean diet and physical activity both help reduce the risk of developing Alzheimer's.

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