title: Limitation of care orders in patients with a diagnosis of dementia.
abstract: The prevalence of dementia is growing with an ageing population. Most persons with dementia die of acute illness and many are hospitalised at the end of life. In the acute hospital setting, limitation of care orders (LCOs) such as Do Not Attempt CPR and Physician Orders For Life Sustaining Treatment (POLST), appear to be underused in patients with dementia. These patients receive the same aggressive life-prolonging therapies as any other patient, despite drastically higher mortality. However, limitation of care orders in patients with dementia is not addressed by current guidelines or policies. Systems and processes for obtaining and documenting LCO need improvement at the individual, organisational and societal level. The issue is controversial amongst the public and poorly understood by clinicians. Balanced and empathetic decision-making requires an individualised approach and recognition of the complexities (legal, ethical and clinical) of this issue. We examine the domains of: (a) treatment effectiveness, (b) burden of care and quality of life and (c) patient autonomy and capacity.
authors.affiliation: Department of Forensic Medicine, Monash University, Victoria, Australia; Ballarat Health Services, Ballarat 3350, Australia. Electronic address: joseph.ibrahim@monash.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Ibrahim
authors.affiliation: Ballarat Health Services, Ballarat 3350, Australia.
authors.forename: Aleece
authors.initials: A
authors.lastname: MacPhail
authors.affiliation: Australian Centre for Evidence Based Aged Care, Faculty of Health Sciences, La Trobe University, 3086, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Winbolt
authors.affiliation: Office of the Public Advocate, 1/204 Lygon Street, Carlton, Victoria 3053, Australia.
authors.forename: Phil
authors.initials: P
authors.lastname: Grano
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D003657:Decision Making; D003704:Dementia; D006760:Hospitalization; D006801:Humans; D008020:Life Support Care; D011788:Quality of Life; D016414:Resuscitation Orders; D028761:Withholding Treatment
keywords: Acute hospital; DNACPR; Dementia; Limitations of care