Family Overprotection Phenomenon with Dying Dementia Patients

B.Z. Aminoff, M.D., Ph.D.

Geriatrics D Department, The Chaim Sheba Medical Center,Tel Hashomer, Israel

The recently developed, Mini-Suffering State Examination (MSSE) scale, objective tool (Aminoff, 1999), evaluates the suffering level of ESD patients. Despite intensive efforts by the medical staff, it was found that the suffering level of dying dementia patients increased until the last day of life (Aminoff et al., 2004). Treatment is lengthy and exhausts the medical and nursing staff, as well as the patients’ families.

Occasionally, the family of an ESD patient who is hospitalized in the geriatric department conducts a fierce altercation with the medical and nursing staff. At this stage the patient often suffers from untreatable or irreversible diseases, an advanced cognitive decline, serious eating disturbances and decubitus ulcers. Family members may demand “maximum treatment” including transfer to an internal medicine department or intensive care unit in order to try and improve the patient’s condition in the hope of keeping their loved one alive.

Frequently, the patient’s condition is unstable and daily becomes more complicated and severe. The likelihood of balancing the condition is slight, despite constant medical intervention. All efforts to explain the increasing seriousness and irreversibility of the patient’s condition to the family only result in additional demands for intensified treatment. We have defined this phenomenon as the syndrome of overprotection of an elderly dying dementia patient. This article was initially published as an Editorial in the American Journal of Hospice and
Palliative Medicine (Volume 22, No. 4, July–August, 2005).

Methods of coping with the family members’ syndrome of overprotection of an ESD patient are unknown. The overprotection phenomenon is an additional cause for unnecessary suffering of dying dementia patients, as well as for the family members themselves. A definition and comprehension of the overprotection phenomenon may help to develop a procedure for prevention of unnecessary additional suffering for dying patients and their family members.