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Don Riesenberg, MD

JAMA. 2000;284:87-89.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Nearly 14 years ago, Volicer et al¹ described an early model of hospice care for patients with advanced Alzheimer disease. In that study, although physicians had a difficult time estimating survival, they successfully emphasized comfort care and documented explicit decisions regarding withholding interventions.

The justification for that model of care is that irreversible dementia is a terminal illness and that patients and caregivers should be given an early opportunity to decide about intensity of care before the disease inevitably progresses. It appears from the article by Morrison and Siu² in this issue of THE JOURNAL that this concept has yet to gain acceptance, at least at 1 hospital at an academic center with a well-established department of geriatric medicine.

Morrison and Siu investigated mortality rates and treatment modes in severely demented vs cognitively intact patients hospitalized with pneumonia or hip fracture.² The authors show that dementia itself . . . [Full Text of this Article]

Author Affiliation: Binghamton VA Clinic, Upstate Medical University, Binghamton, NY.

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