Clinical Review Article| Volume 31, ISSUE 4, P291-303, April 2023

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Dementia Care at the End of Life: A Clinically Focused Review

  • Dax Volle
    Send correspondence and reprint requests to Dax C. Volle, M.D., Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756.
    Department of Psychiatry (DV), Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Published:November 11, 2022DOI:


      • What is the primary questions addressed by this study?
         This review focuses on the care of those with dementia at the end of life, what barriers exist to receiving high quality care, how to address prognostication in advanced dementia, and how to approach symptomatic management in dementia at the end of life.
      • What is the main finding of this study?
         Data is available to guide our understanding of how to counsel patents and families about the natural illness course of dementia, the prognosis after a dementia diagnosis or near the end of life, and how to ameliorate symptoms and suffering in patients with dementia at the end of life.
      • What is the meaning of the finding?
         The adoption of a palliative approach to dementia care, especially at the end of life, has the potential to address historical disparities in the quality of dementia care and to reduce distress in suffering for patients and caregivers.


      With the geriatric population in the United States growing rapidly, the prevalence of dementia is expected to rise concomitantly. As dementia is an invariably progressive and terminal illness, planning for and managing end of life care in dementia is an important part of the overall process of dementia care. Unfortunately, this is often neglected outside of formal palliative and hospice medicine training programs and geriatric psychiatrists are left without preparation on how to manage, as well as counsel patients and families on, this important phase of dementia care. This review aims to explore the potential contributors to this historic disparity in geriatric education and care delivery, as well as its impact, while also attempting to shift the field's focus toward a palliative approach to dementia care. To begin to accomplish this, this review explores the natural illness history/disease trajectory of the various dementing illnesses, as well as the topic of prognostication as it pertains to the end of life for patients with dementia and how this information can be used in advanced care planning and symptom management.

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