End-of-life experiences among elderly nursing home residents with dementia and issues regarding nursing care

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1. ObjectiveThe objective of the present study was to obtain basic data for developing an end-of-life care program for elderly with dementia by elucidating the course of progression during the end-of-life stage. Two survey plans were implemented from 2003 to 2005.2. Summary of the results of Survey 1Data regarding physical and mental conditions from the time of admission to November 2005 were obtained from the medical charts of 5 elderly with severe dementia who were admitted to a nursing home in Niigata Prefecture. One elderly died in May 2003.(1) Bedridden elderly with severe dementia had frequent fever, followed by dysphagia, reduced dietary intake, stridor, and altered conscious level. In addition, elderly who were capable of walking at the time of admission progressed to a bedridden state following falls or fractures, and followed a similar course.(2) Comparison of the course of elderly capable of ingestion and those receiving tubal feeding showed that the latter had fewer days of … More fever than the former, but also had self-extubation of the feeding tube in addition to pneumonia.3. Summary of the results of Survey 2Data regarding body temperature, dietary intake, body weight, and outcome from the time of admission to August 2005 were obtained from the case records of 27 elderly with dementia who were admitted to a nursing home in Chiba Prefecture.(1) A total of 11 of 27 (40.7%) elderly died during a 3-year period.(2) Among the elderly who died, those who were capable of walking one year prior to death and those who were bedridden had different courses of progression during the end-of-life stage. Specifically, the former had behavioral and psychological symptoms of dementia such as wandering and excitement during the year preceding death, and exhibited no notable physical signs.4. SummaryThe above findings indicate that various types of end-of-life experiences exist among elderly with dementia, and that establishment of suitable nursing care for each of these types is necessary. Less