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Older Persons' Opinions About Life-Sustaining Procedures in the Face of Dementia
Dwenda K. Gjerdingen, MD;
Jennifer A. Neff, MD;
Marie Wang;
Kathryn Chaloner, PhD
Arch Fam Med. 1999;8:421-425.
Objective To investigate the attitudes of cognitively normal older adults toward various life-sustaining procedures in the face of dementia.
Methods Participants were 84 cognitively normal men and women (70% response rate), 65 years and older, from a variety of urban and suburban settings, including private homes, assisted-living apartments, transitional care facilities, and nursing homes. In-person interviews were conducted with each participant to obtain information about demographic characteristics, life and health, and desire for various life-sustaining procedures for 4 hypothesized levels of dementia.
Results Approximately three fourths of participants said they would not want cardiopulmonary resuscitation, use of a respirator, or parenteral or enteral tube nutrition with the milder forms of dementia, and 95% or more of participants would not want these procedures with severe dementia. In addition, only one third or fewer participants thought they would want to be hospitalized or given antibiotics if they were severely demented. Logistic regression analysis showed a relationship between participants' desire for life-sustaining procedures and having less education, greater independence, and a higher perceived quality of life.
Conclusions Most surveyed individuals did not desire life-sustaining treatments with any degree of dementia, and the proportion of individuals not desiring such treatments increased with the projected severity of dementia. These findings indicate a need for including dementia in advance directives planning.
From the Departments of Family Practice and Community Health (Drs Gjerdingen and Neff) and Applied Statistics (Dr Chaloner), University of Minnesota, St Paul. Ms Wang is a premedical student at the University of Minnesota, St Paul.
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