Advanced-stages Dementia presents a variety of specific problems that must be born in mind during clinical management. Firstly, the most appropriate clinical environment for the care of advanced dementia must be identified. When deciding such setting, both the patients clinical state and the family/carer situation must be taken into account without forgetting the real availability of, and the access to, the adequate clinical resource. Within an in-patient setting, and for most cases, the clinician must consider the expectations, fears and conceptions held by the patient’s family or carers. Issues most frequently related to advance stages of dementia include that of up till when/where we must apply clinical care when facing potentially severe somatic concurrent illnesses, as in cancer, or when considering a surgical or orthopedic treatment. Among other critical problems clinicians face important decisions on feeding and nutrition, preventative immunization of patients, deciding on prescribing expensive biological therapies for the treatment of concurrent diseases (such as infections), the need for a transfusion, or deciding whether or not to stop specific treatments for Alzheimer’s disease when the disorder is in advanced stages. Some other aspects of growing interest include considering the own patient’s will especially when it was established whilst the patient was entirely competent and when such will was expressed in writing as in the case of the so-called “life will” (“Testamento Vital”). Taken together, it could be posed that comprehensive management of dementia, especially in these advance stages, transcends the strictly medical thinking, rendering at a similar level of importance both clinical management strategies and the ethical content of decisions.
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