Comments on: Rage against the Dying of the Light: Geriatrics, Palliative Care, and Dementia

By: dwensel

dwensel — Sat, 19 Feb 2011 19:29:48 +0000

Thank you for the comments, all very relative and helpful.

By: Barbara Rogers, MSN GNP

Barbara Rogers, MSN GNP — Fri, 18 Feb 2011 16:55:59 +0000

With regard to the driving issue is if the family will not ride with the patient can be a telling symptom.
I have found that dementia is still not diagnosed well, mostly secondary to the fear of the disease and not often pulled together until an acute hospitalization occurs which then provides for a palliative care discussion. As a geriatric NP then allows for discussions of trajectory and often to some goal setting. I have found education is the best tool in my kit.

By: DrPippa

DrPippa — Fri, 18 Feb 2011 07:11:12 +0000

I really liked the visual the speaker created (at least in my mind) of the geriatric approach to dementia and the palliative medicine approach to dementia. Both good but not always complete.
Geriatrics: good at identifying syndromes and atypical sx presentations.
PallMed: good at understanding dementia is a terminal disease.
Certainly a generalization but enhanced the discussion regarding barriers to excellent end of life care in patients with dementia. Now the trick is getting everyone to attend to the palliative care tasks in dementia while being attentive to the varying symptom presentations.

By: Amos.Bailey

Amos.Bailey — Thu, 17 Feb 2011 23:39:43 +0000

Dementia is depressing for patients and families. Carefully assessing for depression and treatment seems clinically to be helpful. You might say that you have depression induced pseudo-dementia superimposed on dementia in many cases.
Need to remember that the number needed to treat to get a response can be 4 or 5 and therefore looking for response and dose escalation or changing med is just as important as starting the medication.