Regular Research ArticlesIncidence and Predictors of Advance Care Planning Among Persons With Cognitive Impairment
Section snippets
Setting
Adults presenting to the University of Pittsburgh Alzheimer's Disease Research Center (ADRC) with complaints of memory or other cognitive impairment consent to and undergo standardized clinical research evaluations consisting of a medical and neurologic history and examination, brain imaging, psychosocial assessment, psychiatric interview, and neuropsychological testing. All ADRC participants have an informant (e.g., spouse, child, sibling, or friend) who has frequent interaction with them and
Baseline Sample Characteristics
As shown in Table 1, most of the subjects were 65 years or older, married, and European American. Men and women were almost equally represented. Slightly less than half the sample had a known family history of dementia and nearly a quarter of the sample had a psychiatric diagnosis of MDD at baseline. Subjects with MCI or mild AD were more likely to be female and have an education beyond high school. There were no other baseline differences between the two groups.
Advance Care Planning
The cumulative incidence
DISCUSSION
This is the first study examining prospectively recorded data on advance directive completion rates in persons at high risk for future decisional incapacity. In the large cross-sectional study by Lingler and associates,28 the majority of 661 persons (71%) with MCI or AD had completed advance directives before presenting to the ADRC for an evaluation of their cognitive symptoms. The current sample was limited to those individuals with MCI or AD who presented to the ADRC with no ACP in place and
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2022, Handbook of Clinical NeurologyCitation Excerpt :Elements of the ACP conversations that are especially important in the context of dementia include dedicating time and special attention to the trajectory of the illness, cognitive decline, and loss of medical decision-making capacity, with early, continuous involvement by family members and others close to the patient. Early discussions, optimally in mild stages of disease, enhance the decision-making abilities of surrogate decision makers, families, and loved ones, reducing the stress and anxiety related to speaking on behalf of patients (Mitchell et al., 2004; Garand et al., 2011). To this end, ACP exists within a minimal set of principles for standard care as best practice in both dementia care and palliative medicine.
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This work was supported by National Institutes of Health grants MH070719 and AG05133. Dr. Lingler was supported in part by a Brookdale Foundation Leadership in Aging Fellowship.
The authors have no disclosures to report.