The Clinical Course of Advanced Dementia

Abstract

To the Editor: Mitchell et al. (Oct. 15 issue)¹ describe the causes of and rates of death among nursing home residents with advanced dementia. Despite the preference of most health care proxies for comfort-focused care, a distressing number of patients had inadequately palliated symptoms and underwent burdensome interventions. This study provides useful data that can guide discussions about care with health care proxies of patients with dementia in all care settings.

The authors do not comment on do-not-hospitalize (DNH) or do-not-resuscitate (DNR) orders. The hospitalization rate of 16.7% among patients in the study by Mitchell et al. was lower than . . .