Advance Care Planning For Dementia Patients

You may be the legal substitute decision-maker for a senior loved one who lacks the mental capacity to make care decisions for themselves.

This could be due to:

  • You were officially appointed by your loved one when they were still competent
  • A guardianship authority has appointed you
  • The law considers you to have close and ongoing contact with the individual (this is usually a spouse, a close relative, or an unpaid caregiver)

Advance Care Plan Benefits

Creating an advance care plan for someone's future medical treatment offers various advantages:

  • It enables people who are close to the patient to reflect on any talks or observations they may have made regarding their values and views concerning their care near the end of life.
  • It will help you prepare for future decisions you may have to make regarding the patient's care, rather than being forced to make judgments in a time of crisis without preparation.

It does not lock you into certain decisions that will be executed automatically in the future. Instead, it provides an opportunity to discuss issues and make statements that can be utilized to guide treatment decisions when they must be made.

What To Do Before Making An Advance Care Plan

Before creating an advance care plan, you must determine whether the individual has communicated their wishes in written or verbal form, and you must adhere to these requests as part of the advance care plan. In addition to formal documentation, this could include diaries, letters, and emails to friends and family.

Even if the individual is deemed to lack legal capacity, you should still try to understand their emotions and factor them into your conclusions.

If they have not left clear instructions, you could consult with other family members or close friends with whom they may have communicated their preferences. Consider the decisions they've made in the past and how they arrived at those conclusions.

This will help you create a strategy that reflects the individual's wishes to the greatest extent possible. If you are unable to determine what the individual would have chosen, you must balance the pros and cons of each course of action and determine what is in their best interests.

Typically, you would create an advance care plan with the assistance and participation of your senior loved one's healthcare providers, such as their general practitioner, the staff of an assisted living facility, or a home care agency.

Challenges To Advance Care Planning

Time constraints, lack of physician training, limited health literacy, fear, and language or cultural issues are common obstacles to the shared decision-making process for ACP completion.

When it comes to dementia care, additional barriers exist like:

  • 40% of respondents, according to a 2014 survey, do not recognize Alzheimer's as a grave illness
  • The risk for early loss of decision-making skills in disease progression
  • Lack of dementia development knowledge among family members
  • Lack of confidence prevents healthcare practitioners from initiating ACP talks
  • Inability to select a healthcare professional to oversee and facilitate continued ACP as the disease advances

To find out more about dementia and its progression, check out Senior Strong’s other resources.

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William Rivers is an editor with a master’s degree in Human Services Counseling at Maine State University. He has more than 20 years of experience working in the senior healthcare industry.
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