Dementia and Hospice Care

Jul 3, 2023 | News

Hospice provides healthcare services to people with a life-limiting illness. People with late-stage dementia can greatly benefit from hospice services. Sometimes symptoms of pain and/or agitation can be misinterpreted as dementia behaviors. The hospice team is quite skilled at being able to address these symptoms in a way which provides a higher quality of life and ensures a greater degree of comfort.

It can be challenging to decide when the best time is to consider hospice for someone with dementia. Some of the guidelines hospice professionals utilize to assess appropriateness are:

  • Communication challenges. When they speak, do they use a full sentence or only a few words? As dementia advances, patients will use fewer words and often become nonverbal. They will often only provide one-word responses, won’t respond, or appear confused when asked a simple question. They may use “word salad”—stringing together random words—or confabulatory speech. For example, they may say that they really enjoyed having lunch at school today even though they haven’t left the home and aren’t in school anymore.
  • Cognitive decline. Exhibiting increased confusion, having difficulty understanding basic concepts, and/or being unable to follow simple instructions.
  • Frequent infections. Patients with late-stage dementia often have frequent urinary tract infections, episodes of pneumonia, sepsis, or infections of the sinuses, ears, skin, and teeth.
  • Decreased activity and function. They may not be able to remain sitting in an upright position without assistance. They will have more difficulty walking on their own. When sitting in a chair, they may frequently slide down or slump over. They have difficulty dressing or undressing themselves. As the condition progresses, patients will usually lose the ability to smile. They are now using their fingers to eat instead of utensils or have difficulty bringing a spoon or fork to their mouth.
  • Unintentional weight loss. A loss of appetite often accompanies late-stage dementia, as well as challenges with swallowing and even chewing. Food and drink may be rejected. They may “pocket” food. This is when the food they are chewing remains inside the cheek rather than being swallowed. They may choke or cough when eating or drinking.
  • Increased hospitalizations/visits to the emergency room. If someone was hospitalized once last year, and this year they have been admitted a few times, for example, this could be an indicator that they may be appropriate for hospice.
  • Other conditions. Changes occurring concurrently with another diagnosis may meet the criteria as well. Some of these include congestive heart failure, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes, or if the patient has a serum albumin level less than 2.5 g/dL.

When considering these factors, it’s important to remember that a person doesn’t have to exhibit all of these findings to meet the criteria for hospice. However, if a person is observed to have a combination of these, it would be highly recommended to contact hospice.

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