Palliative care in dementia: referring to “end of life” is unnecessary

Nobody could disagree with Yorganci and Sleeman that many people with dementia would benefit from holistic, person centred, community based care aimed at palliating distress and discomfort, and continuity is key to providing this.1 But for two reasons, we should shift “the end of life” from the prominent place these authors give it in their article.Firstly, the variable trajectory of dementia progression makes it difficult to distinguish, except in retrospect, between someone who is approaching death and someone who will recover after what turns out to have been a blip. This difficulty contributes to the phenomenon of “disadvantaged dying”23 in frail older people, including those with dementia.Secondly, many such people prefer to “take a day at a time,”4 focusing on managing daily life in the present rather than thinking about the future. They and their families need care that supports them in this daily work and then steps up rapidly…
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