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dementia, falls, fractures, interdisciplinary, never-events, pressure ulcers



  1. Hersh, Mary RN, PhD(c), CHPN, FPCN
  2. Nazarian, Meital Amir MSN, RN, CNS


This article cites compelling evidence indicating that end-stage-dementia patients receive poor palliative care. Some healthcare professionals and many families remain unaware that dementia is a terminal disease. Dementia is an underdiscussed, incurable illness. Often, its mention lies buried within the patient's history and is rarely cited as the reason for hospital admission. Yet, symptoms of advanced dementia are frequently the chief complaints warranting hospitalization to treat hip fractures and control infections due to skin breakdown. The lack of awareness about dementia's terminal trajectory points to an underutilization of palliative care. The 2008 Medicare Never-Events rule, blocking payment for hospital-acquired fractures due to falls and pressure ulcers, presents opportunities to increase palliative care's involvement in patients with this disease. This article reviews the literature, making evidence based suggestions for palliative care teams to heighten interdisciplinary education and collaboration focused on demented patients at risk for falls, fractures, and bedsores. The Medicare rulings present opportunities for palliative care to demonstrate how skilled practitioners engage patients and families in sensitive, decision-focused conversations, prompting surrogates' understanding that dementia is a terminal illness. In addition, these heightened interdisciplinary networks, inspired by palliative care, help ensure patient safety and assist hospitals achieve accountability for healthcare quality.