End-Of-Life Decision Making For Nursing Home Residents With Dementia: A Survey of Nursing Home Social Services Staff.

How people in the United States die, particularly how severely impaired older adults die, has become a topic of widespread interest in the gerontological community in the past 10 years. People in the United States are living longer and dying more slowly of chronic diseases that often shape the last months and years of their lives. The progressive course of chronic diseases blurs the boundary between “living” and “dying” and complicates medical decision making for those who are severely impaired but not necessarily in their last days, weeks, or months of life (Field & Cassel, 1997; Kaufman, 1998). Some clarity about medical care for chronically ill people is emerging in end-of-life decision making for older adults with dementia, particularly of the Alzheimer’s type. Increasingly, experts are rejecting the use of medical interventions for adults in end-stage dementia as a growing body of empirical research is consistently finding that treatments termed “life-sustaining” are often ineffective in sustaining life and quality of life (see Finucane, Christmas, & Travis, 1999; Gillick, 2000; Lacey, 2004; Volicer, 2001). As a result, experts in dementia argue that palliative care or comfort-oriented care should become the dominant paradigm of care for people in end-stage dementia (Callahan, 1995b; Post & Whitehouse, 1998; Solomon & Jennings, 1998; Volicer).

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