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To the Editor: Between 2.5 and 4 million US residents have a life-limiting neurological disorder, including Alzheimer disease or related dementia (ADRD),¹ that will require end-of-life (EOL) care. Although several groups have provided evidence-based suggestions to improve EOL care in general,² as well as desirable outcomes for end-stage dementia, the unique characteristics of ADRD³ create unique difficulties at the end of life. In particular, ADRD does not have a predictable time course and causes cognitive and functional impairments that, in turn, predispose to behavioral symptoms. It also destroys intellectual capacity, personality, and the ability to communicate one's wishes for care and produces intense physical, emotional, and financial burden on the family.

Methods

The US Department of Veterans Affairs and the Alzheimer's Association convened an advisory board to examine the current state of EOL care in ADRD and to draft recommendations for improvement of care. A steering committee reviewed published and unpublished . . . [Full Text of this Article]

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