“At a time when unprecedented numbers of people are enjoying more years of life, this report of the National Academies of Sciences, Engineering, and Medicine describing a way forward for meeting the challenges of persons living with dementia and their care partners and caregivers could not be more timely and welcome. A previous National Academies study addressed the evidence on interventions to prevent or slow cognitive decline and dementia.
“The committee that conducted the present study was charged with reporting on evidence regarding interventions aimed at improving care for persons living with dementia and their care partners and caregivers. Both of these reports emanated from a widely shared desire to avoid dreading living to old age rather than approaching a long life as a reward for a life well lived.
In the waning decades of the 20th century, when the research world “discovered” late-life Alzheimer’s disease and the importance of research to understand and address it, this developing field also recognized the need for quality improvement in caring for persons living with dementia, as well as their care partners and caregivers. Early advances led to findings that essentially helped reduce harm caused by unfortunately common practices in the care of persons with late-stage dementia. Examples included use of mechanical restraining devices (as exemplified by so-called “Geri-chairs”) and chemical restraints, such as harmful overuse of antipsychotics. Today, Geri-chairs are virtually outlawed, and a recent report of the Lancet Commission documents declining use of antipsychotics. Likewise, harmful practices
designed to sustain life, such as the use of feeding tubes and some other forced-feeding techniques, have declined significantly. Yet, while these changes represent progress, they can best be viewed as harm reduction due to existing practices.
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