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Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis
Cain Cindy L, Quill Timothy E. The Hastings Center report, 2024-02-21
Topic: Risk, prevention and care in population studies
Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end-of-life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the "six-month rule" that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision-making capacity. This essay encourages scholars and policy-makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia.
Key findings
- Hospice care has become an integral part of the end-of-life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the "six-month rule" that the majority of the end of life takes place in the final six months of life.
Why it matters
This essay argues that the six-month hospice rule is not a meaningful marker for people with advanced dementia, being both too early for conversations and too late for decision-making capacity. It is about end-of-life care policy and communication, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 16/100
Report — not peer-reviewed. It scored 21 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on institution's track record, so that was left out: it earned 20 of the 97 points we could judge it on, which is 21 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (The Hastings Center report) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 3 / 10 | Report — not peer-reviewed. Named source is an organisational report, not a journal article. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 2 / 6 | Cited 1.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Timothy E. Quill: h-index 54 (OpenAlex, whole career) |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38382036) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 20 / 97 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 20 of the 97 points we could judge it on is 21 out of 100. |
| Total | 21 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1002/hast.1552
- PubMed: 38382036
- Original source →
- Free full text: The Hastings Center Report →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Cain Cindy, L., & Quill Timothy, E. (2024). Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis. The Hastings Center report. https://doi.org/10.1002/hast.1552
Vancouver
Cain Cindy L, Quill Timothy E. Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis. The Hastings Center report. 2024. doi:10.1002/hast.1552. PMID: 38382036.
BibTeX
@article{caincindy2024-38382036,
author = {Cain Cindy, L. and Quill Timothy, E.},
title = {{Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis}},
journal = {The Hastings Center report},
year = {2024},
doi = {10.1002/hast.1552},
pmid = {38382036},
url = {https://doi.org/10.1002/hast.1552}
}
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