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Ladislav Volicer, MD, PhD; Yvette Rheaume, BSN, RN; June Brown, LCW; Kathy Fabiszewski, RN, MS; Roger Brady, MDiv

JAMA. 1986;256(16):2210-2213.

Abstract
A program that limits the extent of medical treatment in patients with advanced dementia of the Alzheimer type was initiated on an intermediate medical ward. Five levels of care were designed to define options that stress maintenance of patient comfort without striving for a maximal period of survival (hospice approach). An optimal care level for each patient recommended by the staff correlated highly with the severity of dementia, but care levels assigned during meetings of family members with the multidisciplinary team for 40 patients correlated poorly with the staff recommendations and the severity of dementia. Intensive nursing care and comfort measures, which included antipyretics, analgesics, and (if necessary) oxygen and anticholinergics, were provided during the terminal phase. Preliminary results indicate that the mortality did not increase significantly during the first year of this program, although the extent of medical care was limited in all patients, and 62% were not treated with antibiotics if they developed symptoms of pneumonia or urinary tract infection.

(JAMA 1986;256:2210-2213)

Author Affiliations
From the Geriatric Research Education Clinical Center, E. N. Rogers Memorial Veterans Administration Hospital, Bedford, Mass (Dr Volicer, Father Brady, and Mss Rheaume, Brown, and Fabiszewski); and the Departments of Pharmacology, Psychiatry, and Medicine (Dr Volicer), Boston University School of Medicine.

Footnotes
Reprint requests to GRECC, E. N. Rogers Memorial Veterans Administration Hospital, 200 Springs Rd, Bedford, MA 01730 (Dr Volicer).

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