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Palliative fever management in Alzheimer patients. quality plus fiscal responsibility
A C Hurley1, B Volicer, M A Mahoney
1Geriatric Research, Education and Clinical Center; Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.
Abstract:
Aggressive medical treatment of infections does not affect the progressive course of dementia of the Alzheimer type (DAT) and has limited effect on the mortality rate. Utilization of health care resources and discomfort during a fever episode were compared in three differing treatment conditions: in 18 patients in a dementia special care unit (DSCU) who received palliative management, 26 patients in a DSCU who were treated aggressively, and 17 DAT patients in traditional long-term care units who were treated aggressively. Both groups of patients in the DSCU had lower discomfort scores, lower utilization of high-cost health care resources, and higher utilization of analgesics and narcotics. A nursing model of care incorporating hospice concepts into the DSCU is suggested.
Insights
Aggressive infection treatment does not alter dementia of the Alzheimer type progression. Palliative care in dementia special care units (DSCUs) reduced patient discomfort and healthcare costs compared to aggressive treatment.
Area of Science:
- Gerontology
- Neurology
- Palliative Care
Background:
- Dementia of the Alzheimer type (DAT) is a progressive neurodegenerative disease.
- Infections are common in DAT patients and can lead to aggressive medical interventions.
- The impact of aggressive medical treatment on DAT progression and mortality is not fully understood.
Purpose of the Study:
- To compare the effects of palliative versus aggressive medical treatment for infections in DAT patients.
- To evaluate healthcare resource utilization and patient discomfort across different care settings.
- To explore the benefits of a nursing model incorporating hospice concepts in dementia care.
Main Methods:
- A comparative study involving three groups of DAT patients: palliative care in a dementia special care unit (DSCU), aggressive treatment in a DSCU, and aggressive treatment in traditional long-term care units.
- Assessment of patient discomfort scores, healthcare resource utilization, and medication use (analgesics, narcotics).
Main Results:
- Aggressive medical treatment did not influence the progression of DAT or significantly impact mortality rates.
- Patients receiving palliative management in a DSCU experienced lower discomfort scores.
- DSCU patients, regardless of treatment intensity, utilized fewer high-cost healthcare resources compared to those in traditional units.
- Palliative care in DSCUs led to increased use of analgesics and narcotics, indicating better symptom management.
Conclusions:
- Aggressive medical treatment for infections offers limited benefits for patients with dementia of the Alzheimer type.
- A palliative nursing model, integrating hospice principles within dementia special care units, can enhance patient comfort and optimize resource allocation.
- This approach suggests a shift towards more compassionate and cost-effective care for advanced dementia.