Older persons' opinions about life-sustaining procedures in the face of dementia

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% respons e rate), 65 years and older, from a variety of urban and suburban settings, including private homes, assisted-living apartments, transitional care fac ilities, and nursing homes. In-person interviews were conducted with each p articipant to obtain information about demographic characteristics, life an d health, and desire for various life-sustaining procedures for 4 hypothesi zed levels of dementia. Results: Approximately three fourths of participants said they would not wa nt cardiopulmonary resuscitation, use of a respirator, or parenteral or ent eral tube nutrition with the milder forms of dementia, and 95% or more of p articipants would not want these procedures with severe dementia. In additi on, only one third or fewer participants thought they would want to be hosp italized or given antibiotics if they were severely demented. Logistic regr ession 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 treat ments with any degree of dementia, and the proportion of individuals not de siring such treatments increased with the projected severity of dementia. T hese findings indicate a need for including dementia in advance directives planning.