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Caregivers refuse Alzheimers medications when patients quality of life threatened

(Philadelphia, PA) A caregiver's assessment of an Alzheimer's patient's quality of life is the key factor in determining if and why some caregivers decline to use a treatment that slows progression of the patient's disease, according to a new study from researchers at the Institute on Aging at the University of Pennsylvania School of Medicine. Their findings set for publication in the October 3rd edition of the Journal of the American Geriatric Society reveal that caregivers are most likely to decline medications slowing Alzheimer's disease if the caregiver assesses the patient's overall quality of life as fair or poor. For example, a husband may decline treatment of his spouse when she can no longer remember family members and can only communicate with them as strangers. When there is risk to the medication, the number of caregivers who decline treatment rises substantially.

"Caregivers have always played a vital role in providing direct care. That is why we call them caregivers. They also make decisions for patients," said Jason Karlawish, MD, an Assistant Professor of Medicine in Geriatrics at Penn's School of Medicine and lead author of the study. "In fact, by the moderate to severe stages of the disease, caregivers make most of the treatment decisions, including when to say 'no' to a particular therapy."

The two-year study evaluated 102 caregivers of patients with mild to severe stages of Alzheimer's disease. Seventeen percent of these caregivers did not want their relatives to take a risk-free medication that could slow the disease, and half of the caregivers did not want their relatives to take medication with a risk of side effects (a three percent risk of gastro-intestinal bleeding.) Patients were evaluated using interviews that assessed the severity of their dementia. Quality of life was measured using both a single question to assess overall quality of life, and a 13-point scale that measured, among other things physical healt
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Contact: David March
david.march@uphs.upenn.edu
215-615-3353
University of Pennsylvania School of Medicine
3-Oct-2003


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