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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: liatayalon0@gmail.com.
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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

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