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ABSTRACT FORM

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Pain and other symptoms

Palliative care for cancer patients

Palliative care for non cancer

patients

Paediatric palliative care

Palliative care for the elderly

The actors of palliative care

Latest on drugs

Pain

Illness and suffering through

media

Marginalisation and social stigma

at the end of life

Palliative care advocacy projects

Prognosis and diagnosis

communication in

different cultures

Communication between doctor-

patient and patient-

equipe

Religions and cultures versus

suffering, death and

bereavement

Public institution in the world:

palliative care policies

and law

Palliative care: from villages to metropolies

Space, light and gardens for the terminally ill patient

End-of-life ethics

Complementary therapies

Education, training and research

Fund-raising and no-profit

Bereavement support

Volunteering in palliative care

Rehabilitation in palliative care

DEMENTIA: WHEN SHOULD TREATMENTS BE STOPPED?

Authors (max 6, presenting author included): Mariolina Congedo

Physicians and families face choices about treatments in patients with dementia especially whenintercurrent diseases shorten life expectancy and worsen quality of life. Highly predictivecharacteristics of antibiotic withholding in pneumonia are severe deterioration, severe

pneumonia, low intake of food and fluids and dehydration. Within 1 month 90% of untreateddementia patients die, versus 27% of patients treated for curative aim and 48% of patients treatedfor palliative aim (van der Steen JT, Ooms ME, Ader HJ et al. Arch Intern Med 2002;162:1753-1760). At 6 months in the end-stage dementia group, the reported mortality is 80% for treated

patients and 63.6% for untreated ones (Rozzini R, Sabatini T and Trabucchi M. Arch Intern Med2003;163:496-497). The option of withholding involves pneumonia being considered as part oterminal condition that should not be prolonged (van der Steen JT, Ooms ME, Ader HJ et al.

Arch Intern Med 2003;163:497-498), but debate is open.

Life-sustaing treatments (LSTs) can be considered basic care not to be denied to anyone, or anoption to be evaluated in clinical cases. Few data are available about physicians attitudes towardwithdrawing or withholding LSTs. In a survey with scenarios concerning dementia alsorespondents were significantly more likely to withhold treatments than to withdraw them oncestarted; dementia patients were more likely to have LSTs withheld or withdrawn than alert ornonterminally ill patients (Farber NJ, Simpson P, Salam T et al. Arch Intern Med 2006;166:560-564). In physicians decisions, personal background, training, personal life values and attitudes toterminal care influence decision making (Hinkka H, Kosunen E, Metsanoja R et al. J Med Ethics2002;28:109-114). Physicians and relatives can agree, but especially in the absence of advancedirectives, they could discuss end-of-life decisions more openly (Rurup ML, Onwuteaka-Philipsen

BD, Pasman HR et al. Patient Education and Counseling 2006;61:372-380).

Session: Neurology & Palliative Care

Chair of the session: Prof. Ignazio R. Causarano

Antea Worldwide Palliative Care ConferenceRome, 12-14 November 2008

Mariolina Congedo

mariolina.congedo@libero.i

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Neurology & Palliative Care