In other words, palliative care focuses on quality of life, but acknowledges that life ends....and with this awful disease, promotion of survival to the point where everyone must live long into the final stage when the body shuts down—fighting it even then—is not necessarily good care.

Most families begin to look seriously at palliative care when the patient is no longer walking or speaking much, and is dependent for most activities. This begins with questioning how aggressive the medical care should be, with usually first questioning antibiotic use, use of medications for things like cholesterol management, or determining if surgery should be done for a fractured hip. While our medical colleagues may press for "curing reversible problems" or "preventing a stroke in the future" (it is their job as an MD to do this), it is the family's responsibility to determine how that fits into Mom or Dad's value system, and recognize that Mom's value system may be different than Dad's so they may be treated differently. The challenge for the caregiver and family is to remove themselves from consideration of what they want. These decisions are not about family; they are about the comfort of the loved one.

Geri has been working with families and dementia since 1978. A retired professor from University of Iowa, Geri has been a consulting professional to the Washington University, St. Louis Alzheimer list for 13 years.