Sterben mit Demenz

Abstract

A third of the elderly population dies with dementia. This poses major and partly unmet needs on relatives, professional carers and medical specialists. Our review summarizes epidemiological risk factors for the increased mortality in demented patients (age, somatic co-morbidity, neuropsychiatric symptoms), current practice (place of death, decision making, complications, medical treatment, course of dying, cause of death, suicide, bereaved relatives), and instruments for the assessment of pain, burden, prognosis and treatment planning in the terminal stage of illness. We describe the current legal situation in Germany and present a brief outline of practical management issues. We also list a number of areas offering leeway for improvement regarding research, training, psycho-education, preparation, diagnosis, treatment and support.

Verstorben an oder mit Demenz? Die Beziehung zwischen demenzieller Erkrankung und Todesursache

“…Die vor allem in fortgeschrittenen Krankheitsstadien anzutreffenden Ess-und Trinkstörungen können zu Aspirationspneumonien, Mangel-/Fehlernährung und Exsikkose führen [10,11]. Krebserkrankungen werden bei Demenzerkrankten erst in einem späteren Stadium diagnostiziert als bei Personen ohne Demenz [12], sollen aber insgesamt seltener nachgewiesen werden [13]. Auch gibt es Hinweise darauf, dass in früheren Demenzstadien eine höhere Suizidrate vorliegt als in der Allgemeinbevölkerung, insbesondere bei Personen mit höherem Bildungsgrad und/oder hoher sozialer/beruflicher Stellung [14].…”

Dying with dementia: most frequent symptoms. A review of the literature / Sterben mit Demenz: die häufigsten Symptome. Eine Literaturübersicht

“…In the last phase of life, differentiation of dementia types is no longer relevant, since the types and prevalence of symptoms are identical in all forms of dementia at this point in time (Lussier, Bruneau, & Villalpando, 2011). In their last year of life, patients with dementia manifest a characteristic clinical picture that, according to the literature, is based on six symptoms often occurring concurrently (Table 3: Indicators of dying with dementia): 1) respiratory distress, often combined with respiratory infections leading to pneumonia; 2) pain; 3) mood swings; 4) mobility restriction leading to confinement to bed followed by pressure ulcers; 5) impaired food and fluid intake, often caused by dysphagia; and 6) behavioural disturbances, especially agitation, restlessness and disorientation (Cervo, Bryan, & Farber, 2006;Chang et al, 2005;Di Giulio et al, 2008;Fabbro, Dalal, & Bruera, 2006;Förstl, Bickel, Kurz, & Borasio, 2010;Hughes, Jolley, Jordan, & Sampson, 2007;Mitchell et al, 2009;Reynolds, Henderson, & Shulman, 2002;Roger Stieber, 2006;van der Steen, 2010;Wowchuk, McClement, & Bond, 2006). Behavioural disturbances play a significant role with regard to the manifestation of symptoms in the last phase of life (Robert et al, 2010;Smith, 2005;Treloar, Crugel, & Adamis, 2009).…”

Supporting dementia patients and their caregivers in daily life challenges: review of physical, cognitive and psychosocial intervention studies

“…decisions on hospitalization, antibiotics or percutaneous endoscopic gastroscopy) . From end‐of‐life studies, there is meanwhile convincing evidence that caregiver education might prevent pathological mourning even after the patients' death . Hence, dementia wards and memory clinics should integrate caregiver education and support activities into therapeutic concepts.…”