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The article discusses concerns on the culture of branding which has emerged in the U.S. It states that the cultural center of the life of Americans has shifted because of the two-way movement of corporation to a person and vice versa. It notes that authors Alexis de Tocqueville and Robert Bellah as well as their co-authors have carefully indicated the tension between Americans' way of living and how it is applicable to their culture.

1. Understand the end-of-life experiences from the perspective of bereaved care partners with sporadic Creutzfeldt Jacob Disease. 2. Evaluate end-of-life experiences from the perspective of bereaved care partners with Alzheimer's dementia or other slower-course dementia syndromes. This qualitative study found differences in caregiver perceptions of end-of-life experiences comparing rapid and slower progression dementia types. One in three older adults dies with or from dementia. While attention is paid to the precise diagnosis of dementia, little is known whether different diagnoses lead to meaningful differences in end-of-life experiences. To compare perspectives on end-of-life experiences between bereaved caregivers of "rapid" type decedents (prognosis of < 1 year) or "slower" type (prognosis of 5-20 years). Secondary analysis of two qualitative studies of palliative care needs in dementia. Semi-structured interviews were conducted with bereaved caregivers: 12 of decedents with "rapid" sporadic Creutzfeldt Jacob Disease and 15 of decedents with Alzheimer's dementia and other "slower" syndromes. We analyzed transcripts thematically and comparatively. Caregivers of decedents with rapid-type dementia had a median age of 59 (range 45-73), 6 female, 9 spouses. Slower caregivers had a median age of 69 (45-82), 9 female, 11 spouses. We identified four main themes. (1) End-of-life preparation for rapid type occurred at diagnosis ∼2 months before death, whereas slower type plans required multiple adaptations. (2) Family disagreements were acute in rapid type, whereas families could resolve disagreements with slower types. (3) Religion and spirituality did not differ by dementia type; caregivers with ongoing religious practices adapted them to patient decline and caregiving responsibilities; others re-connected with religion/spiritualty. (4) Use of hospice: 100% of those with rapid dementia enrolled and 67% died at home; CPs reported difficulty accessing care at the right time or in a disease-adapted way and substantial distress around administration of medication and opioids at end-of-life. Among slower dementia, 60% enrolled in hospice and died at home. While there are similarities in end-of-life experiences by dementia type, there are also meaningful differences. Efforts to improve end-of-life care for dementia should avoid a one-size-fits-all approach, attending to variations in preparation, distressing symptoms, hospice eligibility and experiences by dementia subtype. [ABSTRACT FROM AUTHOR]

Background: Delivering a diagnosis of Alzheimer's disease and related dementias (ADRD) can be challenging not just for patients and families, but also for clinicians. Our objective was to understand dementia specialty care clinicians' perspectives on their role in diagnosis and diagnostic disclosure in dementia., Methods: Qualitative interviews with clinicians from a specialty tertiary dementia care center focused on practices, challenges, and opportunities addressing patient and caregiver needs in dementia. Data was analyzed by an interdisciplinary team using thematic analysis., Results: The 16 participants included behavioral neurologists, social workers, neuropsychologists, and nurses. Themes included the value of providing an accurate diagnosis, the timing and challenges of delivering a diagnosis, the central focus on diagnosis alongside the need for more education on care management, and the role of the interdisciplinary team., Discussion: We identified areas for improvement and strengths that can be built upon or adapted to other settings, including providing clinicians in specialty and primary care settings more guidance and support when diagnostic challenges arise, strengthening interdisciplinary teamwork, and making dementia diagnosis and care more accessible., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Palliative care focuses on reducing suffering and improving quality of life for individuals with serious illness and their families. In an effort to develop palliative care interventions for specialty memory care clinics, this study characterizes memory care providers' perspectives on addressing palliative care needs of people living with dementia (PLWD)., Methods: Qualitative interviews with specialty memory care providers were followed by thematic analysis by a multidisciplinary research team., Results: Provider approaches overlap with key domains of palliative care. Approaches unique to dementia include having a detailed understanding of dementia syndromes, behavioral symptoms, and caregiver burden. Challenges were identified related to disease progression, provider-level factors, and systems and cultural issues. Respondents identified training needed to strengthen a palliative care approach., Discussion: There are many strengths of using memory care teams to address palliative care needs of PLWD. However, they may require additional knowledge and training to strengthen their work., (© 2021 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)