Management

Comprehensive, longitudinal, well-coordinated care delivered by the family physician for both the patient and the caregiver is the cornerstone of effective management of patients with dementia. Patients should be seen regularly in the office, and the physician should be readily available by telephone. The family should maintain frequent contact with the patient and physician. The family physician should update vaccinations, monitor visual acuity and hearing, and address other appropriate health issues. Families should be counseled regarding behavioral and environmental modifications that may be helpful, including reducing hazards in the home for falls and injuries. A discussion regarding the timing of cessation of driving should be undertaken early in the course of treatment. Decisions regarding advanced directives and planning for the later stages of the disease should begin early in the process as well. The patient should legally designate a durable power of attorney for health care. The discussion of the placement of feeding tubes should begin before difficulties with feeding develop. Families should be aware that feeding tubes do not prolong life, are associated with discomfort and medical complications, and are generally not recommended for patients in the final stages of a dementing illness (Li, 2002). The role of palliative care and hospice care should also be discussed early in the course of the illness, when the patient has the opportunity to participate in the decision-making process.

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