The prestigious medical journal, Archives of Internal
Medicine, published a study last month showing that a
significant portion of Medicare expenditures for people with
advanced dementia is spent on aggressive treatments that could have
little clinical benefit. Researchers found that 30
percent of Medicare expenditures for people with advanced dementia
were for hospitalizations during their last year of life.
A few days after reading this research study, I visited
a man caring for his wife, terminally ill with Alzheimer's disease,
at their suburban Chicago home. Ten years ago, at age 61, she began
showing symptoms of her disease. She had tried desperately to hide
her memory impairment from others. However, she had a high profile
job and eventually was forced to take disability leave. For his
part, the husband tried to deny the seriousness of her problems
until she wandered away from home and got lost for many hours. He
sought out the best medical care but after a couple of years, he
realized the limits of medicine. He concluded that medicine might
actually hasten her decline with unnecessary tests and ineffective
treatments. He chose instead what one might call a "soft approach"
to her disease.
He learned to accept her symptoms and create meaningful moments
for her through simple, pleasurable activities. Instead of focusing
on elusive medical treatments, he focused on giving her the best
possible care. His goals were to make her happy and to give her the
best quality of life. He also began to take care of himself,
understanding that his own welfare affected her, for better or
worse. He joined a church choir and played lots of golf. He
downsized to a smaller, less expensive home. And he hired two
caregivers who shared his goals for his wife. One of the
caregivers, a compassionate woman in her 20s, was present during my
visit. She happily recounted many ways they had found to connect
with her over the years, despite progressive decline in her
abilities.
The woman with Alzheimer's disease was now bedridden. She had
not spoken a word in more than a year. She had been enrolled in
hospice for nearly two years, long after she was expected to die.
Her breathing had become labored in recent days but measures were
being taken to keep her comfortable. The husband said that no
extraordinary steps would be taken to sustain her life. Admission
to a hospital was not necessary. Long ago he had given up on
aggressive medicine in favor of comfort care. He and the caregivers
were at peace with this choice. He wished for her to die with
dignity in the safety and comfort of their home. He got his wish
just two days later.
Whether people with advanced dementia remain in their own home
or reside in a care facility, it is possible for them to live and
die in comfort. It takes a concerted effort on the part of many
people to make this a reality. In this case, the husband had the
courage to lead this great effort to its peaceful end. I was
privileged to witness his love in action.
Daniel Kuhn, LCSW is Community Educator for Rainbow Hospice and
Palliative Care, based in Park Ridge.