Advanced dementia: state of the art and priorities for the next decade.
Dementia is a leading cause of death in the United States. This article outlines the current understanding of advanced dementia and identifies research priorities for the next decade. Research over the past 25 years has largely focused on describing the experience of patients with advanced dementia. This work has delineated abundant opportunities for improvement, including greater recognition of advanced dementia as a terminal illness, better treatment of distressing symptoms, increased access to hospice and palliative care services, and less use of costly and aggressive treatments that may be of limited clinical benefit. Addressing those opportunities must be the overarching objective for the field in the coming decade. Priority areas include designing and testing interventions that promote high-quality, goal-directed care; health policy research to identify strategies that incentivize cost-effective and evidence-based care; implementation studies of promising interventions and policies; and further development of disease-specific outcome measures. There is great need and opportunity to improve outcomes, contain expenditures, reduce disparities, and better coordinate care for the millions of persons in the United States who have advanced dementia.
Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts 02131, USA.
Susan L
SL
Mitchell
Betty S
BS
Black
Mary
M
Ersek
Laura C
LC
Hanson
Susan C
SC
Miller
Greg A
GA
Sachs
Joan M
JM
Teno
R Sean
RS
Morrison
D035843:Biomedical Research / Q000592:standards / Q000639:trends*; D003704:Dementia / Q000150:complications / Q000191:economics* / Q000628:therapy*; D005544:Forecasting; D017048:Health Care Costs; D054625:Healthcare Disparities; D017051:Hospice Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D017721:Hospital Costs; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000191:economics; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States