One of my jobs as an editor is to fit the stories we get into the space we have. That means sometimes I have to make choices about what information gets printed and what gets left out. Fortunately, when I'm editing an article like this month's feature by Janet Cromer detailing the work done by the professionals who make up the palliative care team at Harvard Vanguard Medical Associates (HVMA), I have an escape hatch - this letter. So when I had to cut the paragraph describing the team members' expertise in providing palliative care for patients with dementia, I wasn't overly concerned because I knew I could tell you about it here.
Between now and 2040, the segment of the population over the age of 65 is expected to grow by 60 to 90 million people, and the number of people 85 years and older will increase by 8 to 20 million. That means we can expect to see a corresponding rise in the incidence of diseases that are specific to an aging population, including diseases associated with dementia and delirium.
Dementia is a condition that is progressive and often terminal. Because it leads to the loss of cognitive abilities, it affects both long-term and short-term memory, the ability to reason, judgment, planning, and personality. It is a risk for delirium, and the two are often concomitant. Both conditions create financial, physical, and emotional hardships for families as well as difficult challenges for professionals involved in the patient's care.
As Mark Yurkofsky, MD, chief of intense home-based, palliative care, and extended-care programs at HVMA, told Janet, "There are very important steps the patient and the family need to take with dementia, often involving advanced care planning." He went on to explain that the person who is the healthcare proxy needs to be told very specifically what the patient's wishes and values encompass, and what situations, such as aspiration pneumonia, could arise that will require decisions to be made in the patient's best interest.
The goal of palliative care is to prevent and relieve suffering and to support "the best possible quality of life for patients and families regardless of their stage of illness or need for other therapies." Specialists in palliative care need to help patients and families understand their options and to facilitate the making of choices that are consistent with the patient's values and wishes. They also need to help patients and their families anticipate decline. The task is daunting, even without adding the compounding effect of dementia. Fortunately, all of the palliative care program members at HVMA have the expertise to facilitate conversations about these difficult subjects.
Joseph Saling
Correction
In last month's feature about medical ethics at Emerson Hospital, we inadvertently identified Julie McMahon, RN, BSN, CNA, BC, with the wrong job title. Here correct title is Director, Medical Surgical & Pediatric Nursing - Wheeler 4.
