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Constantin Bogdan, MD, PhD, associate professor, geriatrics-gerontology and internal medicine, president of the Romanian Bioethics Committee UNESCO

Abstract

Besides the general principles of palliation, there are also certain palliative interventions depending on the specific terminal evolution of a disease and on the death causes – pre-lethal complications, specific symptoms. Palliative care associated literature reports to a lesser extent the diagnosis of death, the death mechanisms and the pre-exitus specific symptoms.

The Alzheimer disease, in connection with the increased level of population ageing, is associated today with high levels of morbidity and mortality. Statistically speaking, the Alzheimer disease tends to overcome the cancer related mortality and morbidity, today some types of cancer can be cured, things that do not happen in case of the Alzheimer disease for which we do not have in present a curative therapy.

There are particularities in palliative actions to be taken with reference to the specific of the Alzheimer disease. The geriatric concept of continuous care means a continuum between curative care and terminal illness care.

In the case of Alzheimer disease palliative care is longer and the objectives of defining the care of various pathologies that complicate the terminal evolution of the disease are harder to delimit. Other significant difficulty when approaching a patient with Alzheimer is the disturbed communication that complicates the interpretation of patient’s symptoms and needs to include the family into the care team.

Another particularity in case of the palliative care for patients with Alzheimer is that today around 80% of the terminal stages and deaths happen in residential institutions (hospitals, retirement homes, hospices), which limits to a certain degree the family members’ participation in the care team.

The causes of death are not directly linked with the dementia, instead they are caused by the complications of the associated pathologies: respiratory infections is the most frequent cause, then heart and vascular pathologies and cancers, these being the three main aetiologies encountered. We present palliative interventions appropriate for the symptomatology, induced by the mentioned pathologies.

With reference to the investigation of the complications, laboratory analysis may be avoided in order not to cause extra suffering for patients; this ethical principle must govern any therapeutic decision or investigation.

Constantin Bogdan, MD, internal medicine and geriatrics-gerontology PhD, associate professor, Bucharest, Romania Address for correspondence: e-mail: c_bogdan@yahoo.com Abstract Pierre Delore […]