Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008

ABSTRACT FORM

Presenting author DEMENTIA: WHEN SHOULD TREATMENTS BE STOPPED?

Mariolina Congedo
Email:
mariolina.congedo@libero.i
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abstract
• Pain and other symptoms
• Palliative care for cancer patients
• Palliative care for non cancer
patients
• Paediatric palliative care
• Palliative care for the elderly
• The actors of palliative care
• Latest on drugs
• Pain
Authors (max 6, presenting author included): Mariolina Congedo
Physicians and families face choices about treatments in patients with dementia especially when
intercurrent diseases shorten life expectancy and worsen quality of life. Highly predictive
characteristics of antibiotic withholding in pneumonia are severe deterioration, severe
pneumonia, low intake of food and fluids and dehydration. Within 1 month 90% of untreated
dementia patients die, versus 27% of patients treated for curative aim and 48% of patients treated
for palliative aim (van der Steen JT, Ooms ME, Ader HJ et al. Arch Intern Med 2002;162:1753-
1760). At 6 months in the end-stage dementia group, the reported mortality is 80% for treated
patients and 63.6% for untreated ones (Rozzini R, Sabatini T and Trabucchi M. Arch Intern Med
2003;163:496-497). The option of withholding involves pneumonia being considered as part of
terminal condition that should not be prolonged (van der Steen JT, Ooms ME, Ader HJ et al.
Arch Intern Med 2003;163:497-498), but debate is open.
Life-sustaing treatments (LSTs) can be considered basic care not to be denied to anyone, or an
option to be evaluated in clinical cases. Few data are available about physicians’ attitudes toward
withdrawing or withholding LSTs. In a survey with scenarios concerning dementia also,
respondents were significantly more likely to withhold treatments than to withdraw them once
started; dementia patients were more likely to have LSTs withheld or withdrawn than alert or
nonterminally ill patients (Farber NJ, Simpson P, Salam T et al. Arch Intern Med 2006;166:560-
564). In physicians decisions, personal background, training, personal life values and attitudes to
terminal care influence decision making (Hinkka H, Kosunen E, Metsanoja R et al. J Med Ethics
2002;28:109-114). Physicians and relatives can agree, but especially in the absence of advance
directives, they could discuss end-of-life decisions more openly (Rurup ML, Onwuteaka-Philipsen
BD, Pasman HR et al. Patient Education and Counseling 2006;61:372-380).

• Illness and suffering through

media
• Marginalisation and social stigma
at the end of life
• Palliative care advocacy projects

• Prognosis and diagnosis

communication in
different cultures
• Communication between doctor-
patient and patient-
equipe
• Religions and cultures versus
suffering, death and
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to metropolies

• Space, light and gardens for the terminally ill patient

• End-of-life ethics
• Complementary therapies Session: Neurology & Palliative Care
• Education, training and research
• Fund-raising and no-profit Chair of the session: Prof. Ignazio R. Causarano
• Bereavement support
• Volunteering in palliative care
• Rehabilitation in palliative care
• Neurology & Palliative Care