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1.   Adaptation of physical environment in hospitals to care for 
     Alzheimer patients (model Alzheimer units).
1
UI  - 87011925
AU  - Volicer L ; Rheaume Y ; Brown J ; Fabiszewski K ; Brady R
TI  - Hospice approach to the treatment of patients with advanced dementia of
      the Alzheimer type.
AB  - A program that limits the extent of medical treatment in patients with
      advanced dementia of the Alzheimer type was initiated on an intermediate
      medical ward. Five levels of care were designed to define options that
      stress maintenance of patient comfort without striving for a maximal
      period of survival (hospice approach). An optimal care level for each
      patient recommended by the staff correlated highly with the severity of
      dementia, but care levels assigned during meetings of family members with
      the multidisciplinary team for 40 patients correlated poorly with the
      staff recommendations and the severity of dementia. Intensive nursing
      care and comfort measures, which included antipyretics, analgesics, and
      (if necessary) oxygen and anticholinergics, were provided during the
      terminal phase. Preliminary results indicate that the mortality did not
      increase significantly during the first year of this program, although
      the extent of medical care was limited in all patients, and 62% were not
      treated with antibiotics if they developed symptoms of pneumonia or
      urinary tract infection.
MH  - Aged ; Alzheimer's Disease/*THERAPY ; Attitude of Health Personnel ;
      Family ; *Hospices ; Hospital Units ; Human ; Male ; Massachusetts ;
      Middle Age ; Nursing Staff, Hospital ; Patient Care Planning ; Patient
      Care Team ; Support, U.S. Gov't, Non-P.H.S.
SO  - JAMA 1986 Oct 24-31;256(16):2210-3