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Helping Families With End-of-Life Care in Alzheimer's Disease

Paul Kettl, M.D., M.H.A.

Objective: Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability. While this is clearly a tragedy for the individual and the family, the prolonged nature of the disease allows the clinician an opportunity to plan for progressive stages of the disease including the final stages of care. This article reviews opportunities for assisting families in the care of their ill relatives with Alzheimer's disease.

Data Sources: Review articles on end-of-life care and Alzheimer's disease obtained on a search from Ovid on March 2, 2006. Only English-language review articles were included in the search.

Study Selection: Articles were included in the review if they offered clinically relevant material for assisting families in end-of-life care in Alzheimer's disease. Articles between 1998 and 2006 were included. Approximately 10% of the articles listed were included in the review.

Data Synthesis: Clinicians should discuss with family members choices to be made at the end of life in Alzheimer's disease care and work with the family to ensure these wishes are followed. The geriatric psychiatrist plays a central role in these discussions. Other members of the health care team, including nursing care, hospice care, and social work coordinators, all coordinate efforts to deliver optimal end-of-life care. This leads not only to better and more humane care, but also to a cost savings in America's burgeoning health care budget.

Conclusion: Geriatric psychiatrists can play a central role in assisting families in managing end-of-life care in Alzheimer's disease.

(J Clin Psychiatry 2007;68:445-450)

Received June 15, 2006; accepted Jan. 2, 2007. From Penn State College of Medicine, Hershey, Pa.

Dr. Kettl is an employee of Penn State, The Milton S. Hershey Medical Center, Lancaster General Medical Group, and HealthTrac Systems; and has received grant/research support from Forest, AstraZeneca, and Bristol-Myers Squibb.

Corresponding author and reprints: Paul Kettl, M.D., Professor of Psychiatry, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033 (e-mail: