2023 Alzheimer's Association Clinician Scientist Fellowship (AACSF)
Decision-Making Regarding Mechanical Ventilation in Adults with Dementia
How do care providers make treatment decisions for individuals with late-stage dementia near the end of life?
Lauren Pollack, M.D.
University of Washington
Seattle, WA - United States
Background
Dementia is a progressive disease and, as a result, individuals with dementia may require intensive care towards the end of life, such as mechanical ventilation to help with breathing. These care decisions, however, may often be at odds with the wishes of the care recipients and their families. Studies show that individuals and families of those living with dementia report a preference for comfort-focused care at the end of life. Mechanical ventilation, on the other hand, often involves pain, impaired communication and exposure to physical restraints. Moreover, individuals who undergo this procedure – especially “prolonged” ventilation that lasts 4 or more days – are at high risk of short-term mortality. These individuals may also be unable to communicate their end-of-life care wishes, or have family members available that express such concerns. Because of such factors, it is important for medical professionals to fully understand the care wishes of an individual with dementia before the need for ventilation treatment arises.
Research Plan
Dr. Lauren R. Pollack and colleagues will examine the issues around decision-making related to mechanical ventilation for individuals living with later-stage dementia. They will analyze electronic health records for a diverse group of around 4,300 individuals with dementia who were hospitalized at the University of Washington Medical Center between 2011 and 2021. About 500 of these individuals had “high severity” illness, and about 600 were treated with mechanical ventilation in the hospital. The researchers will identify (1) which of the individuals with high severity illness had mechanical ventilation before being admitted to the hospital and (2) which individuals underwent prolonged ventilation while in the hospital. They will then examine the factors that made those individuals more likely to get ventilation treatments. They will also assess whether the care preferences of patients and their families played a role in the medical providers’ treatment decisions.
Impact
Results from this study could help clarify how care providers determine who receives mechanical ventilation and other invasive procedures during late-stage dementia. They could also identify ways to improve communication between care providers and individuals living with dementia, in order to ensure that care decisions at the end of life align more closely with the care recipients’ wishes.