Palliative care for the nursing home resident with dementia.

The prevalence of memory impairment, including dementia, increases exponentially with age. Of people with late-onset dementia, about half have Alzheimer’s, 16% have vascular dementia, and 30% have other forms of dementia.1 Alzheimer’s disease, the most frequent cause of dementia in Western societies, affects an estimated 5 million people in the United States and 17 million worldwide.2 The onset is insidious with manifestations evolving over a period of years from mildly impaired memory to severe cognitive loss. The course is progressive and terminates with mental and functional incapacity and subsequent death.3 As many as 90% of Americans with dementia will be institutionalized before death.4-5 Nursing homes are, therefore, important providers of end-of-life care. Several researchers have highlighted the need to improve the quality of palliative care in the nursing home setting.6-8