End-Stage Dementia:
Guidelines for End-Stage Alzheimer’s Disease & Dementia Related Disorders

LIFE LIMITING CONDITION AS EVIDENCED BY:

• The patient is severely demented.
• Recent decline in functional status: PPS < 50%.
• Dependence in 3 of 6 ADLS such as bathing, dressing, feeding, transfers, continence & ambulation.
• Unintentional, progressive weight loss of 10% over the past 6 months.
• Symptomatic condition or secondary conditions as evidenced by:
  • Ability to speak is limited to 6 intelligible words or fewer in the course of a day or an intensive interview.
  • Unable to consistently or reliably make their needs known.
  • The patient has had one or more of the following medical complications related to dementia during the past year.
  • Aspiration pneumonia.
  • Upper urinary tract infection.
  • Decubitus ulcers, multiple stage 3-4.
  • Fever recurrent after antibiotics.
  • Inability or unwillingness to take food or fluids sufficient to sustain life; not a candidate for feeding tube or parenteral nutrition.
  • Comorbid or other event indicating high probability of death in six months.

HOW WE HELP — END-STAGE DEMENTIA:

• Ongoing education with family and caregivers about disease progression to reduce emergency room visits.
• Help with symptom management, agitation, safety issues.
• Respite care as needed.
• Coordination of treatments for co-morbidities as patient can handle.
• Support and connection to community resources for caregivers.
• Spiritual care for family and patient.