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Guías Médicas por Condición

Alzheimer's and Dementia

When is your dementia patient ready for hospice care? 

Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Patients with dementia or Alzheimer’s are eligible for hospice care when they show all of the following characteristics:

  • Unable to ambulate without assistance 

  • Unable to dress without assistance 

  • Unable to bathe properly 

  • Incontinence of bowel and bladder 

  • Unable to speak or communicate meaningfully (ability to speak is limited to approximately 6 or fewer intelligible and different words) 

Thinking of dementia as a terminal illness from which patients will decline over a matter of years, rather than months, allows healthcare professionals to focus explicitly and aggressively on a palliative care plan.

Intercurrent illnesses associated with advanced dementia include: 
  • Aspiration pneumonia 

  • Pyelonephritis or upper urinary tract infection 

  • Septicemia 

  • Decubitus ulcers, multiple, stage 3-4 

  • Fever recurrent after antibiotics 

Impaired nutritional status: 
  • Difficulty swallowing or refusal to eat 

  • If receiving artificial nutritional support (NG or G-tube, TPN), patient must be exhibiting continued weight loss despite the feedings 

  • Protein calorie malnutrition: 

    • Weight loss over 11% or 

    • BMI<18 or

    • Albumin <3.1 

Co-morbid conditions that significantly impair the dementia patient's health and functionality: 
  • Congestive heart disease or cardiovascular disease 

  • COPD or restrictive lung disease 

  • Cerebrovascular disease, including stroke 

  • Diabetes mellitus 

  • Renal insufficiency 

  • Malignancy

CMS Medicare provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.

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