Caring for patients in the terminal phase of Alzheimer’s disease

Abstract

Regardless of the aetiology of dementia, its terminal phase has a similar clinical picture. This is when progressive multi-organ dysfunction and, ultimately, death occur. At this stage, the therapy of cognitive dysfunction loses its dominant role in favour of treatment that reduces the severity of behavioural disorders and, above all, efforts to intensify the care and ensure the comfort of the patient. Dementia usually coexists with other conditions, presenting a difficult and complex medical and care problem. In these patients, pharmacotherapy for all disorders should be limited to what is necessary, taking into account the multi-drug nature of the disease, as well as the short life expectancy of patients. The benefits versus side effects of therapy should be weighed very carefully, and unnecessary diagnostics, invasive procedures, unnecessary surgery, and burdensome therapeutic interventions classified as persistent therapy (futile care) should be eliminated. In terminal dementia, unnecessary hospitalisations should also be avoided due to the high risk of complications (infections, delirium, bedsores, thromboembolic complications, further deterioration of functional capacity, increased institutionalisation rates, and mortality). In Poland, the primary caregivers for patients with dementia are family members. As the disease progresses, care becomes round-the-clock, imposing a huge burden on the caregiver. At the same time, family caregivers receive little institutional support.