chapter  34
End-of-life and palliative care in dementia
ByJulian C. Hughes, Jenny T. van der Steen
Pages 5

A philosophical question that arises in connection with dementia is when should end-of-life or palliative care begin? In the popular mind, palliative care is associated with dying. So palliative care begins when the person is dying, but when is that? ese are both practical and conceptual problems. ey are even more pointed when it comes to dementia. For dementia is a condition that is variable in both its nature and progression. We can stipulate that end-of-life care in dementia refers to the last 6 or 12 months of life. But why should this be the case? e person with dementia may be quite active 5 months before he or she dies. We could, alternatively, stipulate that endof-life care refers only to the last few hours or days. But this would then ignore all those decisions – about articial nutrition and hydration, the use of antibiotics or cardiopulmonary resuscitation – which are about end-of-life and are oen much better made well before the last few hours or days. It makes much more sense, therefore, to extend the concept of end-of-life backwards; in which case, it is more natural to speak of palliative care.