The Next Pandemic is Already Here and We’re Not Ready For It: Dementia
We are Medically, Morally, and Legally Unequipped for Dementia
32% of people over 85 have Alzheimer’s (Alzheimer’s Association, 2019) and only roughly a third of adults completes an advanced directive for end of life care. (Yadav et al., 2017). This means that the vast majority of people end up experiencing an entirely medicalized death (Schwarz & Benson 2018). This entails people dying in hospitals, surrounded by strangers, anxiety and conflict among loved ones and medical professionals, medical professionals performing heroic life-saving resources at every juncture of their care even to the point of giving CPR and chest compressions on decrepit bodies riddled with cancer and dementia.
So how do we cope with this pandemic?
The answer is the mass adoption of advanced directives that include explicitly what we wish done if we are suffering from dementia. A brief review of standardized state-provided advanced directive templates show that most standard advanced directives fail at sufficiently providing guidance in the case of dementia. The best practice standard is to direct VSED (voluntary stopping eating and drinking) once there is a marked drop in cognitive ability. But there are some, linked here is an example provided by Agingcare.com.
With few exceptions, the lack of leadership around this issue by healthcare professionals and politicians is atrocious. One bright light in this field is Gundersen Lutheran Medical Center what has achieved almost 100% advanced directives in La Crosse WI. The only downside is these advanced directives most likely don’t get very specific about the utilization of VSED after the onset of mind-destroying dementia.
Alzheimer’s Association, 2019 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 15(3), 321–387. doi:10.1016/j.jalz.2019.01.010
Schwarz, B & Benson, J. J. (2018) The “Medicalized Death”: Dying in the Hospital, Journal of Housing For the Elderly, 32:3–4, 379–430, DOI: 10.1080/02763893.2018.1505462
Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., Mante, A., Halpern, S. D., & Courtright, K. R. (2017). Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care. Health affairs (Project Hope), 36(7), 1244–1251. https://doi.org/10.1377/hlthaff.2017.0175