Clinical Care

End of life refers to the period when an older person is living with, and impaired by, a fatal condition, even if the trajectory is unclear or unknown. This period may be years in the case of older people with chronic or malignant disease. Or be very brief in the case of older people who suffer acute and unexpected illnesses or events, such as sepsis, stroke or trauma. [1]

Last days of life is the hours, days or, occasionally, weeks when a person’s death is imminent. This is sometimes referred to as the period when a person is actively dying. [1]

Palliative care is person and family-centred care provided for a person:

• with an active, progressive, or advanced disease
• who has little or no prospect of cure
• who is expected to die
• for whom the primary goal is to optimise the quality of life.

Palliative care helps people live their life as fully and as comfortably as possible with a life-limiting or terminal illness. It identifies and treats symptoms which may be physical, emotional, spiritual or social. [1]

Dementia is a term used to describe a collection of symptoms that are caused by disorders affecting the brain. Dementia affects people’s memory, thinking, mood, behaviour, and the ability to perform everyday tasks. [2]

Dementia is a significant health and aged care issue. In 2024, it was estimated that there were 425,000 Australians living with dementia. [3] Dementia is as a life-limiting condition and currently there is no cure. [3] Death with or from dementia noticeably increases with age. In 2023, dementia was the leading cause of death in Australia. [3]

Therefore, it is essential to recognise the end-of-life needs for people living dementia. It is important to note that palliative care may be required for people living with early or moderate dementia, particularly if they have other clinical conditions that are life-limiting.

There are many different types of dementia. The four most common types are:

• Alzheimer’s Disease
• Vascular dementia
• Lewy body dementia
• Frontotemporal dementia. [4]

Dementia Australia provides information about the types of dementia. Some people can have more than one type of dementia. For example, a person may have both Alzheimer’s disease and vascular dementia. Knowing what type(s) of dementia a person has helps understand and manage dementia symptoms. Different types of dementia may result in specific behavioural symptoms, though there is some symptom overlap

In the later stages of dementia, symptoms typically worsen, affecting memory, communication, and physical abilities. Late dementia involves severe cognitive decline and requires full-time care needs.

A person with late dementia may:

• lose the ability to recognise familiar people
• gradually lose the ability to walk, wash, dress, or perform daily tasks
• experience incontinence
• be affected by other conditions like stroke or arthritis
• struggle to understand speech and surroundings
• lose the ability to talk
• call out occasionally
• forget how to eat or drink, and not recognise food
• have trouble swallowing
• lose significant weight
• become chair or bedfast
• still be able to show emotions and have sensory experiences like hearing and touch. [5]