Advance medical directives and dementia

A document specific to cases of cognitive illness helps ensure that the patient's wishes guide future care.

An advance directive, or living will, is routinely recommended for patients facing serious illness. Most health directives, however, fail to cover the common scenario of Alzheimer’s disease. 

In the two decades Barak Gaster has practiced medicine, he’s seen family and patients struggle to make plans after a diagnosis of Alzheimer's or dementia. He recommends a process in which medical care is outlined at each stage of the disease, and he lays out the structure of a dementia-specific living will. 

In a paper published in JAMA, Gaster addresses how the wishes of Alzheimer’s patients are often unknown to the family.

“One of the largest problems in our health care system how we can better care for patients with Alzheimer’s disease," he said. "The number of people developing Alzheimer’s is growing and our medical system is not at all prepared for it.”

In the paper, co-written by Eric Larson of Kaiser Permanente Washington Health Research Institute and UW Medicine colleague J. Randall Curtis, Gaster made the case for a dementia-specific advance directive, outlining a way for patients to guide the goals for care as the disease reaches advanced stages.

Typical advance directives usually target end-of-life care for say, cancer, or a permanent coma, Gaster wrote. “But standard advance directives are often not helpful for patients who develop dementia."

Gaster advocates for health directives crafted by patients before symptoms of cognitive impairment emerge. “These directives give patients an opportunity to put their intentions in writing,” he said.

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