CLINICAL PRACTICE. Advanced Dementia

N Engl J Med. 2015 Jun 25;372(26):2533-40. doi: 10.1056/NEJMcp1412652.


An 89-year-old male nursing home resident with a 10-year history of Alzheimer’s disease presents with a temperature of 38.3°C, a productive cough, and a respiratory rate of 28 breaths per minute. Nurses report that for the past 6 months he has been coughing at breakfast and having trouble swallowing. He has profound memory deficits, no longer recognizes his daughter (who is his health care proxy), is bedbound, is able to mumble a couple of words, and is unable to perform any activities of daily living. The nurse asks whether he should be hospitalized. How should this patient be evaluated and treated?

Publication types

  • Review

MeSH terms

  • Aged, 80 and over
  • Alzheimer Disease / complications*
  • Alzheimer Disease / epidemiology
  • Alzheimer Disease / therapy*
  • Bacterial Infections / etiology
  • Disease Progression
  • Feeding Methods*
  • Feeding and Eating Disorders / etiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Palliative Care*
  • Practice Guidelines as Topic
  • United States / epidemiology