• Bethel Ann Powers and Nancy M Watson.
• Elaine C. Hubbard Center for Clinical Nursing Research on Aging, University of Rochester School of Nursing, Rochester, New York 14642, USA. bethel_powers@urmc.rochester.edu
• Am J Alzheimers Dis Other Demen. 2008 Aug 1;23(4):319-25.

ObjectiveTo describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL).DesignConcurrent mixed methods (quantitative retrospective chart review and qualitative field study).SettingThree NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit.ResultsResidents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult.ConclusionThe role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.

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