End of Life Care in Inpatient Psychiatry: A Case Study on End-Stage Alzheimer's Disease
TLDR The case shows the need for psychiatrists to manage end-of-life care for dementia patients, including respecting patients' wishes and using hospice services.
This case study examined the challenges of providing end-of-life care for a 78-year-old male with end-stage Alzheimer's disease and behavioral disturbances in an inpatient psychiatric setting. The patient, admitted for uncontrollable physical aggression, was treated with various medications, including olanzapine, which improved his aggression but not his declining food intake and mobility. Despite initial resistance from palliative care, the patient was eventually recommended for hospice care. Concerns were raised about honoring his DNR/DNI status, but policy changes allowed it to be respected. The patient was discharged to a nursing home with hospice care and died nine days later. The study highlighted the need for inpatient psychiatric staff to be better equipped to manage end-of-life care and to involve hospice or palliative care experts when necessary to honor patients' end-of-life wishes.
