A paper by lead author Susan Mitchell, M.D., M.P.H., associate scientist in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, was selected by the Annals of Internal Medicine as one of the 11 most important papers published in 2004 for physicians with active inpatient practices. According to the journal, the articles were identified through a MEDLINE search and 15 major medical journals. Experts were also consulted to help identify the topics that were most important to these physicians. Articles were then selected based on how they confirmed or changed a hospital-based physician’s clinical practice.
Dr. Mitchell’s article, Nursing Home Residents with Advanced Dementia Typically Do Not Receive Optimal Palliative Care, reported on a study that looked at a group of nursing home residents who were terminally ill with cancer and a group suffering from end-stage Alzheimer’s disease. She found that although both groups died at similar rates within a six-month period, residents dying with advanced dementia experienced uncomfortable or aggressive interventions at a rate much greater than did those with cancer, including tube feeding, restraints and intravenous therapy. It was not unusual for residents with advanced dementia to experience distressing signs and symptoms that could have been addressed by palliative care.
Prompted by this discovery, Dr. Mitchell and her colleagues developed a means of estimating the prognosis for nursing home residents with advanced dementia, which identifies factors associated with six-month mortality. This model for predicting survival in this population holds the potential to become a useful tool in determining the best treatment and care environment for patients with advanced dementia in the future.