Abstract: Hospice for dementia patients in Israel? Possible solution: high suffering end-of-life with dementia units.

2nd World Conference on Jewish Social and Medical Services for the Elderly, Jerusalem, Israel, 2004.
Abstract Book, page 111

Hospice for Dementia Patients in Israel? A Possible Solution: Relief of Suffering Units for End-of-Life Dementia Patients

B.Z. Aminoff, MD, PhD

Department of Geriatric Medicine, The Chaim Sheba Medical Center,
Tel-Hashomer, Israel

Dementia is now the third-highest cause of death and affects 7.1% of the population in the developed countries. The course of Alzheimer’s disease and other dementias is long; patients are in a state of complete helplessness, confined to wheelchairs and bedridden, with double incontinence, feeding tubes, malnutrition, dreadful decubitus ulcers and excessive suffering that may continue for months or years. At this stage the illness is defined as terminal, despite an extended life expectancy.
In view of the complexity of the treatment of an ESD patient and the lack of medical, ethical and Halachic (Jewish religious law) solutions, the establishment of a hospice for dementia patients in Israel, based on palliative treatment only, similar to those in the USA, is problematic. As an appropriate solution seems to be nonexistent, we propose a different approach towards ESD patients in Israel that could pertain to other countries as well.
The high level of intractable suffering by ESD patients should be the principal criterion for enrolling these patients in units for the treatment of high level of suffering.
The suffering level of ESD patients may be screened by means of an objective clinical tool, the (MSSE) scale (Aminoff BZ, 1999),that identifies patients with a high-level of suffering (MSSE = 7-10). The latter should be hospitalized within Relief of Suffering Units for ESD patients. The indication for hospitalization in the Relief of Suffering Units is neither the cognitive, functional and nutritional condition, nor any other medical problem, but intensive care to reduce the level of suffering of these patients.
Treatment in the Relief of Suffering Units does not imply euthanasia. The estimated hospitalization period in such a unit is 1 month. Patients whose suffering level diminishes during hospitalization in the unit may be discharged.
The Relief of Suffering Units for the treatment of high-level suffering experienced by ESD patients will be the source for integral medical, nursing, religious, ethical, psychological and sociologic research. Treatment in Relief of Suffering Units for ESD may be a novel approach and a possible solution for coping with the horrendous burden of suffering of these patients, their families, the medical and nursing care staff.