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
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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