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understanding of the risks and burdens, and positive attributes of interventions that may be offered to people with advanced dementia. By rising to the challenge of advanced dementia end-of-life management, SLPs may provide ethically sound practice and facilitate a good and peaceful death, free of suffering, for many people and their families. Declaration The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. Note 1 Ethic of Care is a philosophical approach to health care ethics. See SPA Ethics Education package (SPA, 2014) for further information. References Alzheimer’s Australia. (2014). Dementia care in the acute hospital setting: Issues and strategies . Position Paper 40. Alzheimer’s Australia (WA) and Curtain University. (2010). Key elements of a palliative approach for people with severe and end stage dementia . Retrieved from http:// www.caresearch.com.au/caresearch/portals/0/documents/ whatispalliativecare/NationalProgram/PCDementiaCOP/A5- COP-booklet.pdf Alzheimer’s Organisation. (2012). Alzheimer’s late-end stage care giving. Retrieved from http://www.org/care/ alzheimers-late-end-stage-caregiving Australian Bureau of Statistics (ABS). (2012). Causes of death, Australia, 2010 . ABS cat. no. 3303.0. Canberra: Author. Australian and New Zealand Society for Geriatric Medicine. (2010). Dysphagia and aspiration in older people . Position Paper 12. Sydney: Author. Australian Institute of Health and Welfare (AIHW). (2012). Dementia in Australia . Cat. no. AGE 70. Canberra: Author. Retrieved from http://www.aihw.gov.au/WorkArea/ DownloadAsset.aspx?id=10737422943 Commonwealth of Australia. (2009). A healthier future for all Australians: Final report of the national health and hospitals reform commission . Retrieved from http://www. health.gov.au/internet/nhhrc/publishing.nsf/content/1AFDE AF1FB76A1D8CA257600000B5BE2/$File/Final_Report_of_ the%20nhhrc_June_2009.pdf Coleman, A. M. E. (2012). End-of-life issues in caring for patients with dementia: the case for palliative care in management of terminal dementia. American Journal of Hospice and Palliative Medicine , 29 (1), 9–12. Connor, S., Tecca, M, Lund-Person, J., & Teno, J. (2004). Measuring hospice care: the National Hospice and Palliative Care Organization national hospice data set. Journal of Pain and Symptom Management , 28 (4) 316–328. Daniel, K., Rhodes, R., Vitale, C., & Shega, J. (2013). Feeding tubes in advanced dementia . Position statement. American Geriatrics Society. Retrieved from http://www. americangeriatrics.org/files/documents/feeding.tubes. advanced.dementia.pdf Dekkers,W., Sandman, L., & Webb, P. (2002). Good death or good life as a goal of palliative care. In H. ten Have and D. Clark (Eds.), The ethics of palliative care: European perspectives (pp. 106–125). Buckingham, UK: Open University Press. Dugdale, L. (2010). The art of dying well. Hastings Center Report , 40 (6), 22–24. Finucane, T. E., & Bynum, J. P. (1996). Use of tube feeding to prevent aspiration pneumonia. Lancet , 348 (9038), 1421–1424.

Finucane, T. E., Christmas, C., & Travis, K. (1999). Tube feeding in patients with advanced dementia: A review of the evidence. Journal of the American Medical Association , 282 (14), 1365–70. Gamino, L. A., & Ritter, R. H., Jr. (2012). Death competence: An ethical imperative. Death Studies , 36 , 23–40. Gill, T. M., Gahbauer, E. A., Han, L., & Allore, H. G. (2010). Trajectories of disability in the last year of life. New England Journal of Medicine , 362 (13), 1173–1180. Givens, J. L., Jones, R. N., Shaffer, M. L., Kiely, D. K., & Mitchell, S. L. (2010). Survival and comfort after treatment of pneumonia in advanced dementia. Archives of Internal Medicine , 170 (13), 1102–1107. Hennings, J., Froggatt, K. & Keady, J. (2010). Approaching the end of life and dying with dementia in care homes: the accounts of family carers. Clinical Gerontology , 20 , 114–117. Kapo, J. M., (2011). Dementia. In L. Emanuel and S. Lawrence Librach (Eds.), Palliative care core skills and clinical competencies , (2nd ed.; pp. 464–470). Missouri: Elsevier. Retrieved from http://www.sciencedirect.com/ science/article/pii/B9781437716191001451 Krishna, L. (2011). Nasogastric feeding at the end of life : A virtue ethics approach. Nursing Ethics , 18 (4), 485–494. Kuo, S., Rhodes, R., Mitchell, S., Mor, V., & Teno, J. (2009). Natural history of feeding: tube use in nursing home residents with advanced dementia. Journal of the American Medical Directors Association , 10 (4), 264–270. Lopez, R. P., Amella, E. J., Strumpf, N. E., Teno, J. M., & Mitchell, S. L. (2010). The influence of nursing home culture on the use of feeding tubes. Archives of Internal Medicine 170 (1), 83–88. Li, S. Q., Guthridge, S. L., Aratchige, P. E., Lowe, M. P., Wang, Z., Zhao, Y., & Krause, V. (2014). Dementia prevalence and incidence among the Indigenous and non- Indigenous populations of the Northern Territory. Medical Journal of Australia , 200 (8), 465–469. Mitchell, S. L., Kiely, D. K., & Hamel, M. B. (2004a). Dying with advanced dementia in the nursing home. Archives of Internal Medicine , 164 , 321–326. Mitchell, S. L., Kiely, D. K., Hamel, M. B., Park, P. S., Morris, J. N., & Fries, B. E. (2004b). Estimating prognosis for nursing home residents with advanced dementia. Journal of the American Medical Association , 291 (22), 2734–2740. Mitchell, S. L., Kiely, D. K., Lipsitz, L. A. (1997). The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Archives of Internal Medicine , 157 (3), 327–332. Mitchell, S. L., Miller, S. C., Teno, J. M., Kiely, D. K., Davis, R. B., & Shaffer, M. L. (2010). Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. Journal of the American Medical Association , 304 (17), 1929–1935. Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., … Hamel, M. (2009). The clinical course of advanced dementia. New England Journal of Medicine , 361 (16), 1529–1538. Monteleoni, C., & Clark, E. (2004). Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: Before and after study. British Medical Journal , 329 , 491–494. National Health and Hospitals Reform Commission. (2009). A healthier future for all Australians: Final report . Retrieved from http://www.health.gov.au/internet/nhhrc/ publishing.nsf/content/nhhrc-report

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JCPSLP Volume 17, Number 2 2015

Journal of Clinical Practice in Speech-Language Pathology