Dementia is a life-limiting condition that is associated with a high symptom burden, particularly in the advanced stages of the disease. People with dementia wish to be cared for and to die in their usual place of residence. However, in the UK, over 30% of people with dementia will die in the acute hospital setting. The most frequent causes of hospitalisation among people in the end stages of dementia are pneumonia and urinary tract infections, even though being in hospital is not necessary for optimal treatment. When a person with dementia is approaching the end of life, best practice dictates that a palliative approach to care should be adopted and that, where possible, acute episodic illness should be managed in the community. However, variable levels of community support and limited understanding of the dementia disease trajectory lead to people with end-stage dementia being hospitalised and receiving active treatment rather than palliative and comfort measures. This article will provide an overview of dementia, its associated signs and symptoms and the prognostic signs that indicate a person with dementia is approaching the end of life. It will then discuss the palliative care needs of people with dementia, the reasons why active treatment in an acute hospital setting may be inappropriate and the importance of advance care planning while the person with dementia still has mental capacity.
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