Facing dementia: integrating palliation into all aspects of care.

Dementia is fast becoming a serious public health concern. The lack of understanding of the terminal nature of dementia frequently results in overly aggressive treatment during the end stage of the disease. Nurses need to recognize and encourage a paradigm shiftin the way dementia is perceived and treated, including promoting early initiation of palliative care services.Dementia is often viewed as a simple consequence of aging. It is also often viewed as a cognitive condition rather than a physiological condition-basically a "senior moment" of forgetfulness gone horribly wrong. Both of these views of dementia are inaccurate. Although memory loss is an early symptom, dementia can be more accurately defined as an irreversible failure of the brain. Dementia is, in fact, a terminal disease. And like some forms of cancer or progressive heart disease, dementia results in physiological changes that eventually lead to death.Dementia is a progressive and incurable illness (Chang et al., 2009; Hancock et al., 2003; Willis & Makaza, 2008). However, unlike many other life-limiting illnesses, the progression of dementia does not follow a set linear path. As with any disease process that affects cognition, the progression of dementia is uncertain and varies between individuals. Patients with severely disabling dementia can expect to live much longer than patients with other terminal chronic diseases (Ferri et al., 2005).Dementia is fast becoming a serious public health concern. According to Ferri et al. (2005) and Hancock et al. (2003), an estimated 24.3 million people worldwide have dementia, and 4.6 million new cases are diagnosed every year. This equates to one new case of dementia every 7 seconds. These authors project that the number of dementia cases will double every 20 years, affecting an estimated 42 million people by 2020 and increasing to 81.1 million people by 2040. Given the large number of people currently diagnosed with dementia, the aging of the population, and the projected number of patients who will be diagnosed with dementia in the coming years, perhaps it is time to rethink this disease and time for nurses to recognize and encourage a paradigm shiftin the way dementia is perceived and treated.Nurses are "the primary point of contact between patients and the world of healthcare" (Chunlaka, 2010, p. 2). In view of the predicted increase in the number of patients with dementia, it is imperative that nurses enhance their knowledge in caring for this population (Chang et al., 2009; Hunt, 2007). In particular, education should be provided to nurses regarding the behavioral symptoms associated with dementia (Hancock et al., 2003; Hunt, 2007), pain assessment (Chang et al., 2009; Hancock et al., 2003; Mitchell et al., 2009), as well as nutrition and safety (Hancock et al., 2003).Another area of educational opportunity for nurses is to understand dementia as a terminal illness. There is considerable literature to support this paradigm shiftin the way dementia is perceived (Chang et al., 2009; Hancock et al., 2003; Mitchell et al., 2009; Willis & Makaza, 2008). Research suggests that dementia is one of the leading causes of death in the United States, yet it continues to be rarely thought of as a terminal disease (Mitchell et al., 2009). This lack of understanding of the terminal nature of dementia frequently results in overly aggressive treatment during the end stage of the disease. These aggressive measures are often extremely burdensome, physically and emotionally, to patients and families. It has been shown that during the terminal phase of dementia, patients experience distressing symptoms comparable to those experienced by patients with cancer (Hughes, Robinson, & Volicer, 2005; Mitchell et al., 2009); however, these symptoms often go unrecognized and untreated because they are misidentified as behavioral in nature. By considering dementia as a terminal illness, nurses can initiate more appropriate palliative care measures. …