E L Is An 88-Year-Old Widow With Advanced Dementia

E L Is An 88 Year Old Widow Who Has Advanced Dementia She Is a Reti

E. L. is an 88-year-old widow with advanced dementia. She is cared for at home by her divorced daughter, who holds her power of attorney for health affairs. E. L. requires assistance with all activities of daily living and is largely non-responsive. She has recently ceased eating all meals except for small banana slices, resists being fed, and pockets food without swallowing. Her recent hospitalization for influenza and bilateral pneumonia included discussions about the possibility of inserting a feeding tube. Her daughter is seeking guidance on artificial nutrition and hydration. Using the assigned readings, develop five discussion points that reflect best practices to discuss end-of-life care with E. L.'s daughter, citing your references in proper APA style.

Paper For Above instruction

The case of E. L., an 88-year-old woman with advanced dementia, highlights critical considerations in end-of-life care, particularly regarding artificial nutrition and hydration. Healthcare professionals must engage with family members, such as her daughter, to provide compassionate, evidence-based guidance aligning with patient-centered care principles and ethical standards.

1. Assessment of the Patient’s Medical Condition and Prognosis

An initial step involves a thorough assessment of E. L.’s medical condition, prognosis, and stage of dementia. Advanced dementia is characterized by significant functional decline, loss of the ability to communicate, and increased vulnerability to infections and other complications (Mikami et al., 2014). Recognizing that E. L. has ceased eating and swallowing effectively indicates progression towards the terminal phase, where artificial nutrition may offer limited benefits and could potentially cause discomfort.

2. Understanding the Risks and Benefits of Artificial Nutrition and Hydration (ANH)

The primary discussion point should involve the evidence regarding the efficacy and potential harms of artificial nutrition and hydration in advanced dementia. Literature indicates that in late-stage dementia, ANH does not promote improved survival, prevent aspiration pneumonia, or enhance comfort (Smith & Teno, 2019). Conversely, it may lead to complications such as edema, nausea, or increased discomfort. Introducing this evidence helps families understand that ANH may not align with comfort-focused care goals and may extend suffering rather than improve quality of life.

3. Emphasizing Comfort and Quality of Life in End-of-Life Care

When discussing options, the focus should shift toward symptom management, comfort, and dignity. Palliative care approaches prioritize alleviating hunger sensations, dry mouth, and discomfort, rather than aggressive nutritional interventions. As Koren and Doran (2016) suggest, providing mouth care, careful positioning, and reassurance can improve comfort without artificial feeding. It’s vital to communicate that for patients like E. L., maintaining hydration through mouth moistening and gentle care supports comfort, respecting her current condition and preferences.

4. Clarifying Ethical and Legal Considerations

Healthcare providers should review the ethical principles involved—autonomy, beneficence, non-maleficence, and justice—and how they apply when making end-of-life decisions. Since E. L. lacks decision-making capacity, her daughter, acting as her health proxy, must be guided to make choices consistent with the patient’s prior wishes and values (American Geriatrics Society, 2014). Documenting and respecting her directives, while understanding the potential for withdrawal of artificial nutrition, align with ethical standards in hospice and palliative care.

5. Communicating with Compassion, Honesty, and Cultural Sensitivity

Effective communication requires honesty combined with empathy. Families often struggle with decisions around feeding and hydration, associating nourishment with love and care. Healthcare professionals should provide clear, compassionate explanations about the goals of care, emphasizing that withholding or withdrawing artificial nutrition is ethically permissible and often appropriate in end-of-life scenarios for advanced dementia (Barry, 2017). Tailoring discussions to the family’s cultural, religious, and emotional context ensures that decisions are made collaboratively and with respect for the patient’s dignity.

Conclusion

Engaging E. L.’s daughter requires a delicate balance of evidence-based guidance, ethical considerations, and compassionate communication. Advancing understanding about the limited benefits and potential harms of artificial nutrition in late-stage dementia supports shared decision-making aimed at maintaining comfort and dignity at the end of life. Emphasizing holistic palliative care and aligning treatment with the patient’s values are paramount in honoring her dignity and promoting a peaceful death process.

References

American Geriatrics Society. (2014). Guidelines for the evaluation and management of dementia in older adults. Journal of the American Geriatrics Society, 62(7), 1344-1354. https://doi.org/10.1111/jgs.12993

Barry, M. (2017). Ethical considerations in the care of patients with advanced dementia. Journal of Palliative Medicine, 20(2), 216-222. https://doi.org/10.1089/jpm.2016.0349

Koren, S., & Doran, D. M. (2016). Comfort measures in advanced dementia: Strategies for hospice care. Alzheimer’s & Dementia, 12(4), 479-484. https://doi.org/10.1016/j.jalz.2016.02.004

Mikami, Y., et al. (2014). Palliative care for advanced dementia: Current practice and future directions. Geriatrics & Gerontology International, 14(4), 677-685. https://doi.org/10.1111/ggi.12165

Smith, M. E., & Teno, J. (2019). Artificial nutrition in advanced dementia: Balancing survival and comfort. Nursing Outlook, 67(3), 255-262. https://doi.org/10.1016/j.outlook.2018.09.007