Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-22T18:14:48.530Z Has data issue: false hasContentIssue false
  • English
  • Français

Preferences for end-of-life treatment: concordance between older adults with dementia or mild cognitive impairment and their spouses

Published online by Cambridge University Press:  22 May 2012

Liat Ayalon ,
Yaacov G. Bachner ,
Tzvi Dwolatzky  and
Jeremia Heinik
Liat Ayalon*
Affiliation:
Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat-Gan, Israel
Yaacov G. Bachner
Affiliation:
Department of Sociology of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tzvi Dwolatzky
Affiliation:
Geriatric Department and Memory Clinic, Mental Health Center, Beer-Sheva; and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Jeremia Heinik
Affiliation:
Margoletz Psychogeriatric Center, Ichilov Hospital; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Correspondence should be addressed to: Prof. Liat Ayalon, School of Social Work, Bar Ilan University, Ramat-Gan, Israel, 52900. Phone: +972-3-5317910; Fax: +972-3-934-2056. Email: [email protected].
Get access

Abstract

Background: There is considerable debate about the ability of proxies to adequately reflect patients' preferences regarding end-of-life care, when patients are no longer capable of stating their preferences. This study evaluated concordance in end-of-life preferences between patients with mild cognitive impairment (MCI) or dementia and their spouses.

Methods: A cross-sectional sample of 106 respondents (53 couples) was recruited in two psychogeriatric clinics. Bivariate analyses were conducted to evaluate the degree of agreement between the patients' preferences and those of their spouses.

Results: Patients were more likely to opt for more treatment than their spouses. Moderate agreement between patients and spouses was evident for preferences regarding end-of-life decisions for the patients. There was little concordance between the wishes of spouses regarding their own preferences and what they wanted for the patient or what the patient wanted. When incorrectly predicting patients' preferences, spouses were more likely to ask for treatment.

Conclusions: Our results show that regarding end-of-life preferences for patients, there is moderate agreement between patients and their spouses, but limited evidence for projection of spouses’ preferences on patients (i.e. spouse making a prediction based on own wishes). Potential differences in end-of-life preferences between older adults with MCI or mild dementia and their caregivers should be taken into consideration in the preparation of advance care planning.

Keywords

end of lifeprojectioncaregivingdementia
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1798 - 1804
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Medical Directors Association (2003). White Paper on Surrogate Decision-Making and Advance Care Planning in Long-Term Care. Columbia, MD: American Medical Directors Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision: DSM-IV-TR. Arlington, VA: American Psychiatric Association.Google Scholar
Black, B. S. et al. (2009). Surrogate decision makers’ understanding of dementia patients' prior wishes for end-of-life care. Journal of Aging and Health, 21, 627–650.CrossRefGoogle ScholarPubMed
Chen, W.-T., Wang, S.-J., Lu, S.-R. and Fuh, J.-L. (2002). Which level of care is preferred for end-stage dementia? Survey of Taiwanese caregivers. Journal of Geriatric Psychiatry and Neurology, 15, 16–19.CrossRefGoogle ScholarPubMed
Coppola, K. M., Ditto, P. H., Danks, J. H. and Smucker, W. D. (2001). Accuracy of primary care and hospital-based physicians’ predictions of elderly outpatients' treatment preferences with and without advance directives. Archives of Internal Medicine, 161, 431–440.CrossRefGoogle ScholarPubMed
Derse, A. R. (1999). Making decisions about life-sustaining medical treatment in patients with dementia: the problem of patient decision-making capacity. Theoretical Medicine and Bioethics, 20, 55–67.CrossRefGoogle ScholarPubMed
Emanuel, E. J. and Emanuel, L. L. (1992). Proxy decision making for incompetent patients. JAMA, 267, 2067–2071.CrossRefGoogle ScholarPubMed
Fagerlin, A., Ditto, P. H., Danks, J. H., Houts, R. M. and Smucker, W. D. (2001). Projection in surrogate decisions about life-sustaining medical treatments. Health Psychology, 20, 166–175.CrossRefGoogle ScholarPubMed
Fazel, S., Hope, T. and Jacoby, R. (2000). Effect of cognitive impairment and premorbid intelligence on treatment preferences for life-sustaining medical therapy. American Journal of Psychiatry, 157, 1009–1011.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state:” a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gjerdingen, D. K., Neff, J. A., Wang, M. and Chaloner, K. (1999). Older persons’ opinions about life-sustaining procedures in the face of dementia. Archives of Family Medicine, 8, 421–425.CrossRefGoogle ScholarPubMed
Gramelspacher, G. P., Zhou, X.-H., Hanna, M. P. and Tierney, W. M. (1997). Preferences of physicians and their patients for end-of-life care. Journal of General Internal Medicine, 12, 346–351.CrossRefGoogle ScholarPubMed
Houts, R. M., Smucker, W. D., Jacobson, J. A., Ditto, P. H. and Danks, J. H. (2002). Predicting elderly outpatients' life-sustaining treatment preferences over time: the majority rules. Medical Decision Making, 22, 39–52.CrossRefGoogle ScholarPubMed
Kim, S. Y. H., Karlawish, J. H. T. and Caine, E. D. (2002). Current state of research on decision-making competence of cognitively impaired elderly persons. American Journal of Geriatric Psychiatry, 10, 151–165.CrossRefGoogle ScholarPubMed
Kwok, T., Twinn, S. and Yan, E. (2007). The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments. Journal of Advanced Nursing, 58, 256–262.CrossRefGoogle ScholarPubMed
Mantravadi, A. V., Sheth, B. P., Gonnering, R. S. and Covert, D. J. (2007). Accuracy of surrogate decision making in elective surgery. Journal of Cataract and Refractive Surgery, 33, 2091–2097.CrossRefGoogle ScholarPubMed
Marks, M. A. Z. and Arkes, H. R. (2008). Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences? Medical Decision Making, 28, 524–531.CrossRefGoogle ScholarPubMed
Moorman, S. M., Hauser, R. M. and Carr, D. (2009). Do older adults know their spouses’ end-of-life treatment preferences? Research on Aging, 31, 463–491.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2003). Mild Cognitive Impairment. Oxford: Oxford University Press.CrossRefGoogle ScholarPubMed
Shalowitz, D. I., Garrett-Mayer, E. and Wendler, D. (2006). The accuracy of surrogate decision makers: a systematic review. Archives of Internal Medicine, 166, 493–497.CrossRefGoogle ScholarPubMed
Steinberg, A. and Sprung, C. (2006). The dying patient: new Israeli legislation. Intensive Care Medicine, 32, 1234–1237.CrossRefGoogle ScholarPubMed
Triplett, P. et al. (2008). Content of advance directives for individuals with advanced dementia. Journal of Aging and Health, 20, 583–596.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar