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End-of-life care in advanced dementia — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyEnd-of-life care in advanced dementiaSCE Acute Medicine

A 77-year-old man with frailty is admitted with aspiration pneumonia and delirium. He has advanced dementia, recurrent admissions and is now unable to swallow safely. His lasting power of attorney asks for treatment focused on comfort, consistent with previous wishes. He is breathless and distressed. What is the most appropriate next step in management?

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Correct answer: E — Agree a comfort-focused plan including symptom control, review of antibiotics and clear escalation limits

In advanced dementia with recurrent aspiration and known prior wishes, best-interests decision-making can appropriately prioritise comfort. Symptom control, proportionate antibiotics decisions and explicit escalation limits should be documented with the family and MDT. A lasting power of attorney must be considered when valid and applicable, and invasive escalation may be disproportionate.

Reference: NICE NG97; GMC End of life care guidance