Table 1.

Barriers to Excellent End-of-life Care for Patients with Dementia and Potential Remedies

Barrier	Potential Remedy
Dementia not seen as a terminal illness appropriate for palliative care approach	Educate health professionals and the public; publicize innovative models integrating palliative and primary care
Nature of advanced dementia and treatment decisions	Educate health professionals
Psychological and emotional challenges of withholding treatments such as antibiotics and tube feeding	Have physicians shape patient care plans in more palliative fashion, sharing greater portion of decision-making burden
Assessment and management of pain in cognitively impaired individuals	More broadly disseminate expert guidance on this topic
	Routinely utilize assessments by patient and caregiver, as well as observe patient
	Consider behavior change as a trigger for investigation and possible treatment of pain
Management of behavioral problems and psychiatric symptoms	Educate health professionals
	Refer to psychiatrists, geriatric psychiatrists, and other specialists
Challenging caregiver stress and bereavement issues	Educate of health professionals
	Develop innovative bereavement programs
Economic and systemic disincentives for providing excellent end-of-life care to patients with dementia	Replicate and disseminate innovative programs
	Modify payment systems to align incentives
	Incorporate measures of end-of-life care for patients with dementia to quality improvement and quality measurement efforts