Aging & Social Change: Twelfth Interdisciplinary Conference

Abstract

The current state of advance directives in the United States allows only limited options to people facing a diagnosis of dementia. Existing options focus on choices involving the final stages of dementia, e.g. refusing feeding tubes when one can no longer swallow. Our question was whether these choices responded to the concerns of many Americans. Our hypothesis was that a substantial number might wish their lives to end at earlier stages. Plan: We sampled 1050 people over the age of 50 in the United States. 58% of respondents had experienced loved ones living with dementia. Participants were divided into two groups (n=525). Group One responded to a vignette about four people who experience fatal heart attacks at different stages of their life with dementia. Group Two imagined that they were writing a document directing a health care proxy about when to accept or refuse antibiotics for pneumonia, should they be in a state of dementia. The majority of Group One respondents (56%) would prefer a life trajectory in which they had a final heart attack while still in the first stage of dementia. The majority of Group Two (57%) would choose to refuse antibiotics for a fatal pneumonia sometime in the first or second stage of dementia. Advance directives and end-of-life strategies that focus only on the final stage(s) of dementia fail to reflect the concerns of a majority of Americans over 50.