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When to refer to Hospice: Alzheimer's Dementia

Alzheimer’s is the 5th leading cause of death in the U.S. among Americans 65 years and older. About 70% of Americans with dementia die in a nursing home. In many cases, hospice can improve the end of life experience for patients with advanced dementia / Alzheimer’s disease.

Hospice can support the patient and the family in a number of ways:

  • Educates patients and their families on what to expect in later stages of dementia.
  • Provides a social worker to help patients / families discuss difficult issues, such as artificial hydration/nutrition.
  • Provides grief counseling for the family before, as well as, after the patient’s death.

Here is the criterion that may indicate the patient is appropriate for a hospice referral:

  • Has a diagnosis of Alzheimer’s or advanced dementia.
  • Is unable to dress, bathe, and walk without assistance.
  • Has urinary or fecal incontinence, intermittent or constant.
  • Has no consistently meaningful verbal communication (stereotypical phrases only or ability to speak is limited to 6 or fewer words).
  • Has been treated for one or more of these conditions within the past year: aspiration pneumonia, urinary tract infection, septicemia, pressure ulcers, fever (recurrent after antibiotics) or unintentional weight loss (= or > than 10%) or low serum albumin (< 2.5 gm/dl).

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