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Updated: May 6, 2026
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Oral Health Assessment by Lay Personnel for Older Adults
Published on: February 2, 2020
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A 93-year-old man with advanced dementia and eating problems
1Harvard Medical School and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. smitchell@hrca.harvard.edu
JAMA
|November 8, 2007
Summary
Millions of Americans with dementia face feeding challenges in advanced stages. This case study explores palliative care decisions for nutrition and hydration in end-stage dementia.
Area of Science:
- Geriatrics
- Neurology
- Palliative Care
Background:
- Dementia affects over 5 million Americans, with eating problems common in advanced stages.
- Decisions regarding nutrition and hydration (e.g., tube feeding) are critical in end-stage dementia care.
- Palliative care presents challenges in advanced dementia due to various barriers.
Observation:
- A 93-year-old man with end-stage dementia and hip fracture experienced inadequate oral intake.
- His daughter faced difficult decisions regarding his hydration and nutrition.
- This case highlights the complex crossroads in advanced dementia care.
Findings:
- The discussion reviews dementia epidemiology, natural history, and palliative care barriers.
- It examines pharmacotherapy's role and treatment options for feeding problems.
- An approach for clinician decision support in advanced dementia is suggested.
Implications:
- Clinicians need effective strategies to support families making critical care decisions.
- Compassionate decision-making is essential for patients with advanced dementia.
- Understanding treatment options aids in providing optimal care for dementia patients.
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