Geriatrics D Refusal Phenomenon with End Stage Dementia Patients

Aminoff Bechor Zvi, MD, PhD

Geriatric division, Sheba Medical Center, Tel-Hashomer, 52621; Human Suffering and Satisfaction Research Center, El-Ad, Israel;E-mail: bechorz@yahoo.com

Key words: end stage dementia, refusal phenomenon, suffering

In memory to Geriatrics D department which refused and closed due to failure coping with suffering of end stage and dying dementia patients, caregiver staff, and family members.

The “Geriatrics D Refusal phenomenon” of end stage dementia (ESD) patients has never been was described in medical literature. Refusal phenomenon is entirely clear-cut different from the well-known “burn out syndrome”, and it is separate and independent part of abuse and neglect of elderly patients. In burn out syndrome the staff has motivation to give care, and they understand the importance of the challenge, but are exhausted due to the enormous burden. In the Geriatrics D Refusal phenomenon every effort is made in order not to admit ESD patients and there are numerous techniques are employed of getting rid these patients from the department.

In the Geriatrics D Refusal phenomenon, both sides –the Health Insurance Funds and caregiver hospital staff reject the importance of the challenge to provide appropriate care to ESD patients. The refusal phenomenon of ESD patients by health services is one of main causes of suffering of in end stage dementia.
We developed novel objective tool for measuring suffering in ESD Mini Suffering Examination (MSSE) which presented in Berlin (1999), Jerusalem (2000), Vancouver (2001), Stockholm (2002), Tokyo (2003), , Las-Vegas (2004), Rio-de-Janeiro (2005), Madrid (2006) and the Committee for Labor, Social Services and Health of the Israeli Knesset (2005), and published in Journal Archives of Gerontology and Geriatrics (2004, 38, 2, 123-130).

The results of our research regarding of measuring suffering of dying dementia patients published in American Journal of Alzheimer disease and other Dementias (2004, 19, 4, 243-247) and American Journal of Hospice & Palliative Medicine, (Original article, 2005, 22, 5, 344-348), and was proven that MSSE score on the day of admission was 5.62± 2.31, and increased to 6.89±1.95 at the last day of life (P < 0.0001). ). According to MSSE scale, 63.4% and 29.6% of patients died with high and intermediate level of suffering, respectively. Only one respond for these disturbed results was closing of geriatric department in which developed MSSE scale and provided objective experimental suffering measuring of end stage and dying dementia patients.