Skip to main content
SpringerLink
Log in

Sterven met dementie: wat weten wij ervan?

  • Artikel
  • Published:
Tijdschrift voor Gerontologie en Geriatrie, 2007

Abstract

Dying with dementia: what do we know about it? Death with dementia is increasingly common, yet research on end of life with dementia and end-of-life care for such patients has been sparse. This article reviews recent studies in this area, most of which were done in US nursing homes. Research focused on five domains: prognosis, decision making, treatment, patient’s health and suffering, and family’s circumstances and satisfaction with care. Prognostication focused on developing risk scores for mortality within 6 months or a year, and while decision making was usually studied qualitatively, the other three domains were largely covered by a series of small, retrospective studies. Future direction in research is discussed, including the ongoing CASCADE project in Boston and the Dutch End of Life with Dementia Study (DEOLD). Both of these prospective studies in nursing home residents assess decision making, as well as factors associated with family’s satisfaction and patient suffering. These studies will provide insight into interventions that are most likely to improve end of life care of patients with dementia in the respective countries and elsewhere.

Tijdschr Gerontol Geriatr 2007; 38: 288-297

Samenvatting

Steeds meer mensen zijn bij overlijden dement. Toch is er tot voor kort nauwelijks onderzoek gedaan naar sterven met dementie en de zorg rondom het levenseinde. In dit overzichtsartikel wordt een stand van zaken gegeven over onderzoek op dit gebied. Er zijn vijf deelgebieden te onderscheiden: prognose, besluitvorming, behandelingen, gezondheidstoestand / lijden van de patiënt, en de situatie van de familie en diens tevredenheid met de zorg. Het meeste onderzoek vond plaats in Amerika, in verpleeghuizen. Er zijn risicoscores voor overlijden binnen een half of één jaar ontwikkeld, en in diverse settings is kwalitatief onderzoek naar besluitvorming uitgevoerd. De laatste drie gebieden zijn voornamelijk in kaart gebracht door een serie kleine, retrospectieve onderzoeken. Twee lopende prospectieve onderzoeken bij verpleeghuispatiënten volgen besluitvorming en gaan niet alleen in op de mate van lijden van de patiënt en (on)tevredenheid van familie bij het levenseinde, maar bovenal op associaties met lijden en (on)tevredenheid. Dit zijn het CASCADE project in Boston en omgeving en het Nederlandse onderzoek 'Zorg bij Dementie'. Deze onderzoeken moeten het mogelijk maken om inzicht te krijgen in de meest geschikte interventies om zorg rondom het levenseinde van patiënten met dementie in de betreffende landen en elders te verbeteren.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatuur

  • Centraal Bureau voor de Statistiek, CBS. Sterfte aan dementie. Statistisch kwartaalblad over de demografie van Nederland 2003;51(2):24-8.

    Google Scholar 

  • Mitchell SL, Teno JM, Miller SC, Mor V. A national study of the location of death for older persons with dementia. J Am Geriatr Soc 2005;53:299-305.

    Article  PubMed  Google Scholar 

  • Teno JM. Brown Atlas of Dying - Site of Death: 1989 – 1997, 2000. http://www.chcr.brown.edu/dying/factsondying.htm

  • World Health Organization. Better Palliative Care for Older People – The Solid Facts. WHO, 2004. ISBN 92890-1091-6.

  • Forbes S, Bern-Klug M, Gessert C. End-of-life decision making for nursing home residents with dementia. J Nurs Scholarsh 2000;32:251-8.

    Article  CAS  PubMed  Google Scholar 

  • Kayser-Jones J. The experience of dying: an ethnographic nursing home study. Gerontologist 2002;42(Spec No 3):11-9.

    PubMed  Google Scholar 

  • Mezey M, Dubler NN, Mitty E, Brody AA. What impact do setting and transitions have on the quality of life at the end of life and the quality of the dying process? Gerontologist 2002;42(Spec No 3):54-67.

    PubMed  Google Scholar 

  • Pinderhughes ST, Morrison RS. Evidence-based approach to management of fever in patients with end-stage dementia. J Palliat Med 2003;6:351-4.

    Article  PubMed  Google Scholar 

  • Parker-Oliver D, Porock D, Zweig S. End-of-life care in U.S. nursing homes: a review of the evidence. J Am Med Dir Assoc 2005;6(3 Suppl):S21-30.

    Article  Google Scholar 

  • Sampson EL, Ritchie CW, Lai R, Raven PW, Blanchard MR. A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia. Int Psychogeriatr 2005;17:31-40.

    Article  CAS  PubMed  Google Scholar 

  • Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med 2004;19:1057-63.

    Article  PubMed  Google Scholar 

  • Blasi ZV, Hurley AC, Volicer L. End-of-life care in dementia: a review of problems, prospects, and solutions in practice. J Am Med Dir Assoc 2002;3:57-65.

    Article  PubMed  Google Scholar 

  • Kettl P. Helping families with end-of-life care in Alzheimer’s disease. J Clin Psychiatry 2007;68:445-450.

    Article  PubMed  Google Scholar 

  • Thomas RE, Wilson D, Sheps S. A literature review of randomized controlled trials of the organization of care at the end of life. Can J Aging 2006;25:271-93.

    Article  PubMed  Google Scholar 

  • Volicer L, Rheaume Y, Brown J, Fabiszewski K, Brady R. Hospice approach to the treatment of patients with advanced dementia of the Alzheimer type. JAMA 1986;256:2210-3.

    Article  CAS  PubMed  Google Scholar 

  • Volicer L, Hurley AC, Blasi ZV. Scales for evaluation of End-of-Life Care in Dementia. Alzheimer Dis Assoc Disord 2001;15:194-200.

    Article  CAS  PubMed  Google Scholar 

  • Volicer L, Hurley AC, Blasi ZV. Characteristics of dementia end-of-life care across care settings. Am J Hosp Palliat Care 2003;20:191-200.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Volicer L, Gerritsen DL, Kruse RL, Ribbe MW, Mehr DR. Defining severe dementia with the Minimum Data Set. Int J Geriatr Psychiatry 2006;21:1099-106.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Kruse RL, Ooms ME, Ribbe MW, van der Wal G, Heintz LL, et al. Treatment of nursing home residents with dementia and lower respiratory tract infection in the United States and The Netherlands: an ocean apart. J Am Geriatr Soc 2004;52:691-9.

    Article  PubMed  Google Scholar 

  • Porock D, Oliver DP, Zweig S, Rantz M, Mehr D, Madsen R, et al. Predicting death in the nursing home: development and validation of the 6-month Minimum Data Set mortality risk index. J Gerontol A Biol Sci Med Sci 2005;60:491-8.

    PubMed  Google Scholar 

  • Kruse RL, Mehr DR, Boles KE, Lave JR, Binder EF, Madsen R, et al. Does hospitalization impact survival after lower respiratory infection in nursing home residents? Med Care 2004;42:860-70.

    Article  PubMed  Google Scholar 

  • Steen JT van der, van der Wal G, Mehr DR, Ooms ME, Ribbe MW. End-of-life decision making in nursing home residents with dementia and pneumonia: Dutch physicians' intentions regarding hastening death. Alzheimer Dis Assoc Disord 2005;19:148-55.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Mehr DR, Kruse RL, Sherman AK, Madsen RW, D'Agostino RB, et al. Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationally. J Clin Epidemiol 2006;59:970-9.

    Article  PubMed  Google Scholar 

  • Sloane PD, Zimmerman S, Hanson L, Mitchell CM, Riedel-Leo C, Custis-Buie V. End-of-life care in assisted living and related residential care settings: comparison with nursing homes. J Am Geriatr Soc 2003;51:1587-94.

    Article  PubMed  Google Scholar 

  • Williams CS, Zimmerman S, Sloane PD, Reed PS. Characteristics associated with pain in long-term care residents with dementia. Gerontologist 2005;45 (Spec No 1):68-73.

    PubMed  Google Scholar 

  • Munn JC, Hanson LC, Zimmerman S, Sloane PD, Mitchell CM. Is hospice associated with improved end-of-life care in nursing homes and assisted living facilities? J Am Geriatr Soc 2006;54:490-5.

    Article  PubMed  Google Scholar 

  • Munn JC, Zimmerman S, Hanson LC, Williams CS, Sloane PD, Clipp EC, et al. Measuring the quality of dying in long-term care. J Am Geriatr Soc 2007;55:1371-9.

    Article  PubMed  Google Scholar 

  • Helton MR, Steen JT van der, Daaleman TP, Gamble GR, Ribbe MW. Een cultuurvergelijkend onderzoek naar behandelbesluiten van artsen met betrekking tot dementerende verpleeghuispatiënten met pneumonie. Tijdschr Gerontol Geriatr 2007;38:6-13.

    CAS  PubMed  Google Scholar 

  • Mitchell SL, Kiely DK, Hamel MB, Park PS, Morris JN, Fries BE. Estimating prognosis for nursing home residents with advanced dementia. JAMA 2004;291:2734-40.

    Article  CAS  PubMed  Google Scholar 

  • Mitchell SL, Kiely DK, Hamel MB. Dying with advanced dementia in the nursing home. Arch Intern Med 2004;164:321-6.

    Article  PubMed  Google Scholar 

  • Mitchell SL, Morris JN, Park PS, Fries BE. Terminal care for persons with advanced dementia in the nursing home and home care settings. J Palliat Med 2004;7:808-16.

    Article  PubMed  Google Scholar 

  • Mitchell SL, Kiely DK, Jones RN, Prigerson H, Volicer L, Teno JM. Advanced dementia research in the nursing home: the CASCADE study. Alzheimer Dis Assoc Disord 2006;20:166-75.

    Article  PubMed  Google Scholar 

  • Engel SE, Kiely DK, Mitchell SL. Satisfaction with End-of-Life Care for Nursing Home Residents with Advanced Dementia. J Am Geriatr Soc 2006;54:1567-72.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Mitchell SL, Frijters DHM, Kruse RL, Ribbe MW. Prediction of six-month mortality in nursing home residents with advanced dementia: validity of a risk score. J Am Med Dir Assoc 2007;8:464-8.

    Article  PubMed  Google Scholar 

  • Teno J. Toolkit of Instruments to Measure End-of-Life Care. After-Death Bereaved Family Interview: Hospital version; Hospice version; Nursing Home version. August 2000. http://www.chcr.brown.edu/pcoc/linkstoinstrumhtm.htm

  • Teno JM. Measuring end-of-life care outcomes retrospectively. J Palliat Med. 2005;8 (Suppl 1):S42-9.

    Article  PubMed  Google Scholar 

  • Teno JM, Licks S, Lynn J, Wenger N, Connors AF Jr, Phillips RS, et al. Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 1997;45:508-12.

    CAS  PubMed  Google Scholar 

  • Caron CD, Griffith J, Arcand M. Decision making at the end of life in dementia: how family caregivers perceive their interactions with health care providers in long-term care settings. Journal of Applied Gerontology 2005;24:231-47.

    Article  Google Scholar 

  • Caron CD, Griffith J, Arcand M. End-of-life decision making in dementia. Dementia 2005;4:113-36.

    Article  Google Scholar 

  • Toscani F, Di Giulio P, Villani D, Brunelli C, Gentile S, Spadin S. Dying with advanced dementia in long-term care geriatric institutions: a retrospective study. Ingediend voor publicatie.

  • Aminoff BZ, Adunsky A. Their last 6 months: suffering and survival of end-stage dementia patients. Age Ageing 2006;35:597-601.

    Article  PubMed  Google Scholar 

  • Aminoff BZ, Purits E, Noy S, Adunsky A. Measuring the suffering of end-stage dementia: reliability and validity of the Mini-Suffering State Examination. Arch Gerontol Geriatr 2004;38:123-30.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Ooms ME, Muller MT, Wal G van der, Ribbe MW. Wel of niet curatief behandelen van een pneumonie bij psychogeriatrische patiënten: een ‘handreiking’ voor verpleeghuisartsen. Tijdschrift voor Verpleeghuisgeneeskunde 2003;27(2):6-8.

    Google Scholar 

  • Brandt HE, Deliens L, Ooms ME, van der Steen JT, van der Wal G, Ribbe MW. Symptoms, signs, problems, and diseases of terminally ill nursing home patients: a nationwide observational study in the Netherlands. Arch Intern Med 2005;165:314-20.

    Article  PubMed  Google Scholar 

  • Miller SC, Mor V, Teno J. Hospice enrollment and pain assessment and management in nursing homes. J Pain Symptom Manage 2003;26:791-9.

    Article  PubMed  Google Scholar 

  • Schonwetter RS, Han B, Small BJ, Martin B, Tope K, Haley WE. Predictors of six-month survival among patients with dementia: an evaluation of hospice Medicare guidelines. Am J Hosp Palliat Care 2003;20:105-13.

    Article  PubMed  Google Scholar 

  • Wallace JB, Prevost SS. Two methods for predicting limited life expectancy in nursing homes. J Nurs Scholarsh 2006;38:148-53.

    Article  PubMed  Google Scholar 

  • Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc 2003;51:213-21.

    Article  PubMed  Google Scholar 

  • Hertogh CM, Ribbe MW. Ethical aspects of medical decision-making in demented patients: a report from the Netherlands. Alzheimer Dis Assoc Disord 1996;10:11-9.

    Article  CAS  PubMed  Google Scholar 

  • Rurup ML, Onwuteaka-Philipsen BD, Pasman HR, Ribbe MW, van der Wal G. Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursinghome patients with dementia. Patient Educ Couns 2006;61:372-80.

    Article  PubMed  Google Scholar 

  • Forbes S. This is Heaven's waiting room: end of life in one nursing home. J Gerontol Nurs 2001;27:37-45.

    CAS  PubMed  Google Scholar 

  • Gessert CE, Elliott BA, Peden-McAlpine C. Family decision-making for nursing home residents with dementia: rural-urban differences. J Rural Health 2006;22:1-8.

    Article  PubMed  Google Scholar 

  • The AM, Pasman R, Onwuteaka-Philipsen B, Ribbe M, van der Wal G. Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study. BMJ 2002;325:1326.

    Article  PubMed  Google Scholar 

  • Shield RR, Wetle T, Teno J, Miller SC, Welch L. Physicians "missing in action": family perspectives on physician and staffing problems in end-of-life care in the nursing home. J Am Geriatr Soc 2005;53:1651-7.

    Article  PubMed  Google Scholar 

  • Miller SC, Teno JM, Mor V. Hospice and palliative care in nursing homes. Clin Geriatr Med 2004;20:717-34.

    Article  PubMed  Google Scholar 

  • Somogyi-Zalud E, Zhong Z, Lynn J, Hamel MB. Elderly persons' last six months of life: findings from the Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 2000;48(5 Suppl):S131-9.

    CAS  PubMed  Google Scholar 

  • Lubart E, Leibovitz A, Shapira A, Tischenko O, Peled Z, Baumoehl Y, et al. Satisfaction with the care of institutionalized psychogeriatric patients, as reflected by a survey of their relatives. Arch Gerontol Geriatr 2004;38:45-50.

    Article  PubMed  Google Scholar 

  • DeSilva DL, Dillon JE, Teno JM. The quality of care in the last month of life among Rhode Island nursing home residents. Med Health R I. 2001;84:195-8.

    CAS  PubMed  Google Scholar 

  • Travis SS, Loving G, McClanahan L, Bernard M. Hospitalization patterns and palliation in the last year of life among residents in long-term care. Gerontologist 2001;41:153-60.

    CAS  PubMed  Google Scholar 

  • Travis SS, Bernard M, Dixon S, McAuley WJ, Loving G, McClanahan L. Obstacles to palliation and end-of-life care in a long-term care facility. Gerontologist 2002;42:342-9.

    PubMed  Google Scholar 

  • Evers MM, Purohit D, Perl D, Khan K, Marin DB. Palliative and aggressive end-of-life care for patients with dementia. Psychiatr Serv 2002;53:609-13.

    Article  PubMed  Google Scholar 

  • Cohen-Mansfield J, Lipson S. Medical decision-making around the time of death of cognitively impaired nursing home residents: a pilot study. Omega (Westport) 2003-2004;48:103-14.

    Google Scholar 

  • Bekelman DB, Black BS, Shore AD, Kasper JD, Rabins PV. Hospice care in a cohort of elders with dementia and mild cognitive impairment. J Pain Symptom Manage 2005;30:208-14.

    Article  PubMed  Google Scholar 

  • Gessert CE, Haller IV, Kane RL, Degenholtz H. Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life. J Am Geriatr Soc 2006;54:1199-205.

    Article  PubMed  Google Scholar 

  • Sampson EL, Gould V, Lee D, Blanchard MR. Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age Ageing 2006;35:187-9.

    Article  PubMed  Google Scholar 

  • Pautex S, Herrmann FR, Le Lous P, Ghedira M, Zulian GB, Michon A, Gold G. Symptom relief in the last week of life: is dementia always a limiting factor? J Am Geriatr Soc 2007;55:1316-7.

    Article  PubMed  Google Scholar 

  • Formiga F, Olmedo C, Lopez-Soto A, Navarro M, Culla A, Pujol R. Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers. Palliat Med 2007;21:35-40.

    Article  PubMed  Google Scholar 

  • Formiga F, Pujol R. Differences in end of life care in patients who died with dementia during acute hospital admissions. Age Ageing 2006;35:451-2; author reply 452.

    Article  PubMed  Google Scholar 

  • Mitchell SL, Kiely DK, Miller SC, Connor SR, Spence C, Teno JM. Hospice care for patients with dementia. J Pain Symptom Manage 2007;34:7-16.

    Article  PubMed  Google Scholar 

  • Richardson SS, Sullivan G, Hill A, Yu W. Use of aggressive medical treatments near the end of life: differences between patients with and without dementia. Health Serv Res 2007;42(1 Pt 1):183-200.

    Article  PubMed  Google Scholar 

  • Hanson LC, Eckert JK, Dobbs D, Williams CS, Caprio AJ, Sloane PD, Zimmerman S. Symptom Experience of Dying Long-Term Care Residents. J Am Geriatr Soc 2007 Aug 28; [Epub ahead of print].

  • Keay TJ, Taler GA, Fredman L, Levenson SA. Assessing medical care of dying residents in nursing homes. Am J Med Qual 1997;12:151-6.

    Article  CAS  PubMed  Google Scholar 

  • McCarthy M, Addington-Hall J, Altmann D. The experience of dying with dementia: a retrospective study. Int J Geriatr Psychiatry 1997;12:404-9.

    Article  CAS  PubMed  Google Scholar 

  • Pasman HR, Onwuteaka-Philipsen BD, Kriegsman DM, Ooms ME, Ribbe MW, van der Wal G. Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med 2005;165:1729-35.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Ooms ME, Ader HJ, Ribbe MW, van der Wal G. Withholding antibiotic treatment in pneumonia patients with dementia: a quantitative observational study. Arch Intern Med 2002;162:1753-60.

    Article  PubMed  Google Scholar 

  • Black BS, Finucane T, Baker A, Loreck D, Blass D, Fogarty L, et al. Health problems and correlates of pain in nursing home residents with advanced dementia. Alzheimer Dis Assoc Disord 2006;20:283-90.

    Article  PubMed  Google Scholar 

  • Steen JT van der, Ooms ME, van der Wal G, Ribbe MW. Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment. J Am Geriatr Soc 2002;50:1681-8.

    Article  PubMed  Google Scholar 

  • Koopmans RT, van der Sterren KJ, van der Steen JT. The 'natural' endpoint of dementia: death from cachexia or dehydration following palliative care? Int J Geriatr Psychiatry 2006 Oct 5; [Epub ahead of print]

  • Higginson IJ. End-of-life care: lessons from other nations. J Palliat Med 2005;8 Suppl 1:S161-73.

    Article  PubMed  Google Scholar 

  • Verelst SG, Pasman HR, Onwuteaka-Philipsen BD, Ribbe MW, van der Wal G. Ervaringen van familie met de besluitvorming rond kunstmatige toediening van vocht en voedsel (ktvv) bij mensen met dementie in het verpleeghuis. Tijdschr Gerontol Geriatr 2006;37:51-8.

    CAS  PubMed  Google Scholar 

  • Schulz R, Boerner K, Shear K, Zhang S, Gitlin LN. Predictors of complicated grief among dementia caregivers: a prospective study of bereavement. Am J Geriatr Psychiatry 2006;14:650-8.

    Article  PubMed  Google Scholar 

  • Hebert RS, Dang Q, Schulz R. Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: findings from the REACH study. J Palliat Med 2006;9:683-93.

    Article  PubMed  Google Scholar 

  • Maust DT, Blass DM, Black BS, Rabins PV. Treatment decisions regarding hospitalization and surgery for nursing home residents with advanced dementia: the CareAD Study. Int Psychogeriatr 2007 Sep 10;1-13 [Epub ahead of print].

  • Steinhauser KE. Measuring end-of-life care outcomes prospectively. J Palliat Med 2005;8 (Suppl 1):S30-41.

    Article  PubMed  Google Scholar 

  • Brandt HE, Deliens L, van der Steen JT, Ooms ME, Ribbe MW, van der Wal G. The last days of life of nursing home patients with and without dementia assessed with the palliative care outcome scale. Palliat Med 2005;19:334-42.

    Article  PubMed  Google Scholar 

  • Steel K, Ljunggren G, Topinkova E, Morris JN, Vitale C, Parzuchowski J, et al. The RAI-PC: an assessment instrument for palliative care in all settings. Am J Hosp Palliat Care 2003;20:211-9.

    Article  CAS  PubMed  Google Scholar 

  • Ahronheim JC, Morrison RS, Morris J, Baskin S, Meier DE. Palliative care in advanced dementia: a randomized controlled trial and descriptive analysis. J Palliat Med 2000;3:265-73.

    Article  CAS  PubMed  Google Scholar 

  • Steen JT van der, Toscani F, Di Giulio P,Werner P, Boogaard JA, Zysberg A,Volicer L. Treatments in patients dying with dementia: a cross-cultural perspective. Journal of the American Geriatrics Society 2007. Geaccepteerd voor publicatie. [letter to the Editor].

Download references

Author information

Authors and Affiliations

  1. www.bsl.nl/shop/tijdschrift-voor-gerontologie-en-geriatrie-0167-9228.html

    J. T. van der Steen

Authors
  1. J. T. van der Steen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. W. Ribbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. T. van der Steen.

Additional information

Epidemioloog, wetenschappelijk medewerker, VU medisch centrum, EMGO Instituut, afdeling Verpleeghuisgeneeskunde en afdeling Sociale Geneeskunde

Verpleeghuisarts, hoogleraar Verpleeghuisgeneeskunde, VU medisch centrum, EMGO Instituut, afdeling Verpleeghuisgeneeskunde

Correspondentie: dr.ir. Jenny T. van der Steen, VU medisch centrum, EMGO Instituut, afdeling Sociale Geneeskunde, Van der Boechorststraat 7, 1081BT Amsterdam; tel. 020-4449694; fax 020-4448387;Email j.vandersteen@vumc.nl

About this article

Cite this article

van der Steen, J.T., Ribbe, M.W. Sterven met dementie: wat weten wij ervan?. GEEG 38, 255–263 (2007). https://doi.org/10.1007/BF03074863

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03074863

Search

Navigation