The Graying of America: Challenges and Controversies: Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia

The Graying of America: Challenges and Controversies: Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia

By Muriel R. Gillick*

* Muriel R. Gillick, M.D., is a geriatrician and palliative care specialist at Harvard Vanguard Medical Associates in Boston, Massachusetts and a Clinical Professor in the Department of Population Medicine at Harvard Medical School.

Excerpt from The Graying of America: Challenges and Controversies: Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia, 40 J.L. Med. & Ethics 51 (Spring, 2012)

America is aging. But even more striking than the rise in the proportion of the population over age 65 is the unprecedented number of individuals who are living into their eighties and nineties. While many people remain robust well into advanced age, the dramatic increase in the number of the oldest old has brought with it an epidemic of Alzheimer's disease and other dementias. Dementia is a highly prevalent condition -- currently 5.4 million Americans have Alzheimer's disease, a number which may rise to 16 million by 2050 if there is no break-through in the prevention or treatment of the disease -- but it disproportionately affects those over age 85, striking between one-third and one-half of this cohort. 1 Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades.

Dementia deserves special attention, in a way that other diseases such as cancer or heart disease do not, quite apart from the numbers of those affected. By its very nature, individuals afflicted with Alzheimer's disease can participate to only a limited degree, if at all, in decisions about their care. And although dementia is an incurable, ultimately fatal disease, its duration is long: while recent estimates indicate that survival is considerably shorter than the 5-10 years traditionally cited, median survival from diagnosis to death is nonetheless greater than three years. 2 Dementia therefore does not fit the mold of a typical "terminal illness" for which programs such ...

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