Prevalence and decision-making in advanced dementia

Area of Science:

• Gerontology
• Internal Medicine
• Neurodegenerative Diseases

Background:

• Dementia represents a significant public health challenge due to its high prevalence and associated economic burden.
• Advanced dementia (AD) patients frequently require hospitalization, particularly within internal medicine services.
• Understanding the care provided to these patients is crucial for improving health outcomes.

Purpose of the Study:

• To determine the prevalence of advanced dementia (AD) admissions in internal medicine.
• To analyze the diagnostic and therapeutic interventions employed for these patients.
• To assess the adequacy of care and family communication.

Main Methods:

• A descriptive study utilizing retrospective analysis of medical records.
• Inclusion criteria: patients with Global Deterioration Scale (GDS) 6-7 dementia admitted to Internal Medicine.
• Data collection included a telephone interview with family members.

Main Results:

• 11% of internal medicine admissions were patients with advanced dementia (AD).
• Infections were the primary cause of admission (72%), with a 37% mortality rate.
• Therapeutic interventions were extensive, but adequacy of care (34%) and palliative care involvement (13%) were low. Family awareness of complications was also limited (42%).

Conclusions:

• Advanced dementia (AD) admissions are common, with a significant proportion originating from elderly care residences.
• High mortality rates underscore the severity of illness in this population.
• There is a critical need to improve therapeutic adequacy and advance care planning for hospitalized AD patients.