Objective. To describe the last year of life of people with dementia, their symptoms, care needs, use of and satisfaction with health services and the bereavement state of the respondent.
Methods. The study is drawn from the Regional Study of Care for the Dying, a retrospective sample survey of the carers, family members or others who knew about the last year of life of a random sample of people age 15 and over dying in the last quarter of 1990. The samples were drawn in 20 English health districts which, although self-selected, were nationally representative. There was a total of 3696 patients (response rate of 69%) dying from all causes. Within this sample, 170 dementia patients were identiยฎed and compared with 1513 cancer patients.
Results. The symptoms most commonly reported in the last year were mental confusion (83%), urinary incontinence (72%), pain (64%), low mood (61%), constipation (59%) and loss of appetite (57%). Dementia patients saw their GP less often than cancer patients and their respondents rated GP assistance less highly. Dementia patients needed more help at home compared with cancer patients, and received more social services; 78% of respondents for dementia patients and 64% for cancer said they had come to terms with the patient's death.
Conclusion. Patients dying from dementia have symptoms and health care needs comparable with cancer patients. Greater attention should be given to these needs. (# 1997 by John Wiley & Sons, Ltd.) KEY WORDSรdementia; palliative care; health services; informal carers Dementia is a major concern for nations in Europe . The population prevalence of dementia increases with age, rising to one in four people age 85 . There is little clear evidence on the aetiology of dementia, of which Alzheimer's and cerebrovascular disease are the most common types. Supportive management and help for informal carers are the main objectives of health services. Patients die with the disease, if not directly of it. However, dementia varies in intensity, and not all people suering with it come to the attention of services.
Concern for palliative care has developed over the past two decades. Hospices and palliative care services were initially started to provide for younger patients with cancer; but the United Kingdom Standing Medical and Nursing Advisory Committee (Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory Committee, 1992) has recommended that palliative care servicesรin primary care, specialist commu-