the degeneration of The cognitive functions is the tribute the more cruel the nature charge of the which had the audacity to live longer. Today, it is difficult to find a family where there is someone with Alzheimer’s or another frame dementing, unable to recognize his children and grandchildren and to perform the daily tasks more elementary.
unlike The advances that have occurred in other degenerative diseases such as cardiovascular disease and cancer, however, the pathway clinic of arriving at more advanced stages of dementia, the treatment options, the use of medical interventions for aggressive and unhelpful and the burden of suffering faced by them, tend to be poorly evaluated.
Susan Mitchell and collaborators have just published a study conducted in 22 “nursing homes” for the elderly in Boston region, which helps to better understand the terminal nature of the dementia advanced. In it, 323 patients were followed for a minimum period of 18 months.
The criteria for inclusion were the following:
1) Age equal to or greater than 60 years;
2) Score 5 or 6 on the Scale of Performance on Cognitive test in which the holders of the cognitive functions of normal have score zero, while those that are in advanced stages of deterioration receive 6;
3) Stadium 7 on the Scale of Global Deterioration, a phase in which the cognitive impairments are very severe (inability to recognize family members), the verbal communication becomes minimal, the dependency to perform routine activities is total, comes the inability to walk, urinary and fecal incontinence.
See also: – Dementia in the elderly
Although very sick, these patients represent a significant share of the patients with dementia, in any country. In the period of 18 months, the mortality rate reached 54,8%. The survival average was 1.3 year. The main causes of death were pneumonia, episodes, febrile, and eating disorders.
In just 6 months, the mortality reached 25%. Died about 46% of those who had pneumonia, 44% of the presented episodes of febrile and 28% of those with eating disorders.
In the last 3 months of life, 40% of the residents received some type of medical intervention more aggressive: hospitalization in the emergency room, hospitalizations, parenteral nutrition (intravenously) or placement of gastric tube.
Those who were least subject to these interventions usefulness is questionable were those with family members or guardians are informed and able to understand the terminal nature of the frame of dementia.
Episodes of shortness of breath, pain, agitation, the emergence of pressure sores, aspiration of liquid through the airway, occurred in 40% to 50% of the cases studied, and became more frequent in the last days of life.
The importance of this work is to document that, in stadiums more advanced the dementia should be understood as conditions able to take patients in the terminal phase, regardless of the existence of other diseases. The majority of the deaths is not caused by acute events such as myocardial infarctions, strokes, cancer or decompensation insufficiency of the heart; the framework dementing is the base pathology responsible for the complications that lead to death.
With a mortality of 25% in six months and survival average of a little over a year, the expectation of life in dementia advanced is equivalent to that of patients with some types of cancer disseminated or severe heart failure (stage IV).
While the index of mortality of most common diseases has decreased in the last decades, the of dementia continues to increase. Doctors, family members, and those responsible for the planning of medical support must be prepared to face the challenge of taking care of those that arrive to the phases demenciais the most advanced, saving-the interventions useless that is a burden on the health system and cause even more suffering.