Critical Decisions in Advanced Dementia

Last Reviewed: March 4, 2019

What You’ll Learn

  1. Understand the prevalence of and management strategies for common medical complications in people with advanced dementia, including swallowing problems, infections, and pain.
  2. Describe the pros and cons of long-term feeding-tube placement and hand feeding, factors to consider when eating and swallowing issues arise, and communication tips for discussing these complications with caregivers/family.
  3. Understand how to assess for pain in patients with advanced dementia and describe non-pharmacologic and pharmacologic strategies for managing pain.
  4. Describe strategies for identifying and managing infections in people with advanced dementia and decision-making considerations for caregivers/family.

This course was created with generous support from the nonprofit Gary and Mary West Health Institute.

What You’ll Earn

CAPC members can earn the following free continuing education credits:

  • Case Management: 1.00 CE
  • Licensed Professional Counselors: 1.00 CE
  • Medicine: 1.00 CME, 1.00 ABIM MOC (Medical Knowledge Only)
  • Nursing: 1.00 CNE
  • Social Work: 1.00 CE (NASW)
  • Social Work: 1.00 CE (NYSED)

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Tools & Resources


Considerations for Eating Problems in Advanced Dementia

Last Updated: February 26, 2019

Tips for careful hand-feeding, swallowing safety, and increasing the appeal of food. Center to Advance Palliative Care, 2019.


Communication Tips for Discussing Feeding Tubes in Dementia

Last Updated: March 1, 2019

Four communication tips for clinicians when discussing use of feeding tubes for people with advanced dementia. Center to Advance Palliative Care, 2019.


Principles of Pharmacologic Pain Management in People Living with Dementia

Last Updated: February 26, 2019

Considerations for analgesics prescribing in people living with dementia.

Assessing Needs of People Living with Dementia

Last Updated: March 29, 2019

Recommended validated assessment tools for common comorbid conditions.


Medicare's Hospice Benefit for Beneficiaries with Alzheimer's Disease

Last Updated: February 26, 2019

Alzheimer's Association FAQs about the hospice eligibility for people living with dementia.


FAST Scale

Last Updated: February 26, 2019

For staging and prognosis after a dementia diagnosis.


Course References: Critical Decisions in Advanced Dementia

Last Updated: February 26, 2019

Course citations. Center to Advance Palliative Care, 2019.

Cindy Barton, MSN, GNP, BC. Nurse Practitioner, UCSF Memory and Aging Center.

Andrew E. Esch, MD, MBA. Consultant Center to Advance Palliative Care.

Stefanie Bonigut, LCSW. Family Services Manager. Alzheimer's Association of Northern California and Northern Nevada.

Jim Palmer, MSW, LCSW. Palliative Care Social Worker. Mount Sinai Hospital.

Marta Kazandijan, MA, CCC-SLP, BSC-S. Director, Division Speech Pathology and Swallowing. New York Presbyterian Queens and Silvercrest Center for Nursing and Rehabilitation.

Gina Decker. Caregiver.

Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN. Consultant, Center to Advance Palliative Care.

Komal D’Souza, MD. Palliative Medicine, Northwestern Medicine.*

Karl Bezak, MD. Clinical Assistant Professor of Medicine, Palliative Care and Medical Ethics, University of Pittsburg (UPMC).*

Melissa Bakar, MD. Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

Nora Brennan, RN. Cardiology. University of Pennsylvania Hospital System.

Gail Gongaware, RN, BSN, CCM, MS. Education manager, Education and Training, VNSNY.

Kristin Chouinard, RN, CHPN. Gerontology. North Shore Elder Services, Partners Healthcare.

Philip Higgins, PhD, LICSW. President, Lighthouse Counseling of Salem, Inc.

*indicates ABIM Peer Reviewer

Contact information: For technical questions about online activity or continuing education credits, contact or 212-201-2674.

Provided by the Icahn School of Medicine at Mount Sinai.

The Courses

Discussing Your Patient’s Dementia Diagnosis

Disclosing a dementia diagnosis to patients and caregivers in a way that is sensitive, clear, and s…

Communicating About What to Expect as Dementia Progresses

Helping patients and caregivers understand challenges they may face as dementia worsens.

Planning for the Future with People Living with Dementia and Their Caregivers

Enabling patients and caregivers to plan ahead for the financial, legal, and other impacts of demen…

View all courses in the unit

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