End-of-life care in dementia: a review of problems, prospects, and solutions in practice.

The purpose of this literature review was to assess the current state of affairs in end-of-life care for persons with dementia, to identify barriers to the provision of high-quality care, and to describe exemplary programs that have discovered ways to overcome these barriers. The literature reviewed included English-language articles published since 1990, obtained by searches of Medline, presentations at meetings and conferences, and the Internet. Barriers to quality terminal dementia care identified by this review include: (1) measurement issues regarding quality of care and quality of life, (2) inappropriate interventions stemming from lack or disregard of advance directives, cost considerations, healthcare system factors, and caregiver factors, (3) poor symptom management involving both professional and family caregivers, and (4) current health policy formulated by federal or state governments, insurance companies, and health maintenance organization. High-quality care for persons with dementia at the end of life is possible and is currently being provided in some settings. Further research into areas identified in this review is necessary if the quality of care being provided to this population is to improve.