Behavioral and Psychological Symptoms in Moderate to Severe Alzheimer's Disease: A Palliative Care Approach Emphasizing Recognition of Personhood and Preservation of Dignity
Affiliations: [a] Geriatric Psychiatry, Providence Health Care, and Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada | [b] Ethics Services, Providence Health Care, and Centre for Applied Ethics, University of British Columbia, Vancouver, BC, Canada | [c] Physician Program Director, Hospice Palliative Care Program, Providence Health Care, and Division of Palliative Care, University of British Columbia, Vancouver, BC, Canada
Correspondence:
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Correspondence to: Dr. Michael J. Passmore, Mount St. Joseph Hospital – Ward 1South, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada. Tel.: +1 604 874 1141; Local: 78230; Fax: +1 604 877 8157; E-mail: passmoremd@gmail.com.
Abstract: The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in moderate to severe Alzheimer's disease (AD) can be challenging, and ethical dilemmas often arise. Clinicians often perceive a disconnect between evidence-based guidelines and the challenges of treating BPSD in moderate to severe AD. Reconciliation of salient ethical issues can help bridge this disconnect. In view of the fact that AD is a progressive and ultimately fatal disease, and given that there are often competing considerations when managing BPSD in moderate to severe AD, we propose a palliative care approach that prioritizes the recognition of personhood and the preservation of dignity. We present case illustrations, discuss the concepts of dignity and personhood during palliative care in AD, and encourage the use of the bioethical grid in navigating complex clinical challenges.
