Critter Corner: An Advance Directive Specifically for Dementia

Dear Angel,

I recently read about Advance Directives that deal only with dementia. What is included in them and is it a good idea to create them in addition to other incapacity planning documents?

Thanks!

Dee Rectiffs

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Dear Dee,

An Advance Medical Directive is a legal document that outlines your specific wishes regarding medical and health care decisions, including end-of-life care. Advance Medical Directives are helpful in recording the types of decisions that might need to be made, and to let others know—both your family and your healthcare providers—about your preferences.

The number of people living with dementia is expected to nearly triple worldwide by 2050. This is one of the reasons why some in the medical community now see a need to expand the scope of the Advance Directive. This was formally addressed in an opinion piece in the December 2017 issue of the Journal of the American Medical Association, where the authors made a case for crafting an Advance Directive specifically for Dementia. Our proprietary 4-Needs Advance Medical Directive® contains a comprehensive dementia-specific Advance Directive.

Here are some reasons for a dementia-specific Advance Directive:

• Dementia is a progressive disease. Cognitive decline often occurs over the course of years or even decades. That means that standard Advance Medical Directives, which dictate decision-making in times of crisis, aren’t always the right fit.
• A dementia-specific advance directive addresses a range of questions based on how cognitive decline typically progresses. Not only does this allow loved ones to make specific choices regarding health care and quality of life, it frees family members from difficult decisions and painful arguments. This includes decisions about undergoing a range of medical tests, medical care, and end-of-life interventions.
• Questions about treatment such as antibiotics, the placement of a pacemaker, the use of dialysis, blood transfusions, respirators or feeding tubes can all be addressed within the framework of the document.

The dementia-specific advance directive proposed by the authors of the JAMA essay divides cognitive decline into three phases – mild, moderate and severe. The individual indicates his or her health care goals for each phase of dementia.

The dementia-specific directive (and all other incapacity planning documents) should be filled out before any signs of dementia have presented themselves, and the document should be revisited regularly for updates.

As with all Advance Directives, it’s important to have these documents drafted by an experienced elder law attorney, such as the attorneys at the Farr Law Firm. And it’s vital to have your directives available for when they are needed (which is why our firm uses Docubank!)

Hope this is helpful,

Angel