GENERATIONS – Journal of the American Society on Aging

help alleviate this concern by enabling people to express and document their wishes. Completed dementia directives can also alle- viate some of the anxiety family members face when making medical decisions on behalf of a loved one with dementia. Rather than needing to guess what their loved one might have wanted, healthcare proxies can turn to the dementia directive to help them feel more comfortable that the medical decisions they are making on behalf of their loved one more likely reflect what their loved one would have wanted. The growing value placed on person-cen- tered care and shared decision-making holds that medical care that is more closely aligned with patient wishes is higher quality care (Dy et al., 2015). As the number of people living with dementia in the United States rises, it is incum- bent upon us to provide people the opportunity

to express—and document—their wishes in the event they lose the ability to make decisions for themselves in the special case of this disease. A dementia directive is not intended to take the place of the complex conversations that fami- lies and physicians will need to have at the bed- side. Instead, it is intended to help guide those conversations by giving insight into what a per- son would have wanted. Making medical deci- sions that incorporate the person’s input, in the form of specific written guidance, will almost always be better than making such decisions without such guidance. Barak Gaster, M.D., is a professor of medicine at the University of Washington School of Medicine in Seattle, where he has built a program to train primary care providers to identify dementia early and to help patients and families navigate through disease progression.

References Centers for Medicare & Medi­ caid Services. 2015. “Advance Care Planning as an Optional Element of an Annual Wellness Visit.” tinyurl. com/jd8mmwh. Retrieved Septem- ber 28, 2018. Dy, S. M., et al. 2015. “Measuring What Matters: Top-ranked Qual- ity Indicators for Hospice and Pal- liative Care from the American Academy of Hospice and Palliative Medicine and Hospice and Pallia- tive Nurses Association.” Journal of Pain and SymptomManagement 49(4): 773–81.

Gaster, B., 2017. “Advance Directive for Dementia.” www.dementia- Retrieved September 28, 2018. Gaster, B., Larson, E. B., and Cur- tis, J. R. 2017. “Advance Directives for Dementia: Meeting a Unique Challenge.” Journal of the Ameri- can Medical Association 318(22): 2175–6.

Rolnick, J. A., Asch, D. A., and Halpern, S. D. 2017. “Delegalizing Advance Directives—Facilitating Advance Care Planning.” New Eng- land Journal of Medicine 376(22): 2105–7. Volandes, A. E., et al. 2009. “Video Decision Support Tool for Advance Care Planning in Dementia: Ran- domised Controlled Trial.” BMJ 338: b2159.

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