Clinical momentum in the care of older adults with advanced dementia: What evidence is there in the medical record?

This research letter explores the concept of "clinical momentum" in the care of older adults with advanced dementia. Clinical momentum refers to the tendency for interventions to be performed near the end of life, often resulting in excessive treatment. The study specifically focuses on the use of feeding tubes in patients with advanced dementia as an example of overtreatment. The researchers conducted a retrospective case-control study using electronic health records to identify patients with dementia who received a permanent feeding tube and compared them to controls who did not receive a feeding tube. The study aims to identify markers of clinical momentum in the medical records. The findings indicate that patients with advanced dementia who received a permanent feeding tube had longer hospital stays and more events such as discussions about goals of care and consultations for palliative care. The study suggests that prolonged exposure to a healthcare system that prioritizes interventions for isolated problems can result in care that does not align with guidelines. However, it is important to note that the study has limitations, including a small and nondiverse sample. [Extracted from the article]