TL;DR
Get health and wellness essentials delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
In a randomized survey of nearly 6,000 U.S. adults, participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for one without dementia. Advance directives influenced recommendations, but dementia status and the surrogate’s own preferences also mattered.
Survey participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for a similar patient without dementia, even when an advance directive requested treatment, according to a University of Colorado Anschutz study published in JAMA Network Open. The findings suggest that a patient’s documented wishes may not, on their own, determine how a surrogate decision-maker views care.
The researchers surveyed nearly 6,000 U.S. adults in a randomized online experiment. Participants considered scenarios involving seriously ill, hospitalized older adults. Researchers varied whether a patient had dementia, whether an advance directive requested life-sustaining or comfort-focused care, and whether a physician recommended treatment.
For patients with dementia and no advance directive, participants recommended life-sustaining treatment in 15.6% of scenarios. That share rose to 41.0% when the directive requested life-sustaining treatment and fell to 7.6% when it requested comfort-focused care. The figures describe recommendations in the survey scenarios, not actual treatment decisions or patient outcomes.
For patients without dementia, participants recommended life-sustaining treatment in 38.9% of scenarios without a directive, 66.3% when a directive requested that treatment and 14.4% when it requested comfort-focused care. The study also found that surrogate decision-makers’ own preferences shaped recommendations, alongside the patient’s dementia status and documented wishes.
How Dementia Shaped Treatment Recommendations
The results matter because they point to a gap between what a patient records in advance and what another person may recommend if the patient can no longer communicate. The lower support for life-sustaining care in dementia scenarios persisted even when the directive favored treatment, according to the study. That does not show what happens in every real clinical decision, but it highlights how assumptions about dementia and quality of life may influence surrogate judgments.
The authors say advance care planning involves more than completing a form. Discussing personal values with a chosen decision-maker may help that person understand the patient’s preferences, including how those preferences apply to future situations. The study also points to the importance of selecting someone willing and able to represent the patient’s wishes, rather than simply substituting their own preferences.
For families and clinicians, the findings offer a reason to discuss both specific medical choices and the values behind them. Such conversations cannot guarantee that a particular treatment will be provided, but they can give a surrogate more information about how the patient would want decisions approached.
As an affiliate, we earn on qualifying purchases.
What the Survey Tested
An advance directive records a person’s preferences for future medical care if they become unable to communicate or make decisions. A surrogate decision-maker is someone authorized or selected to make health care decisions on a patient’s behalf in that situation. The study examined how these factors interacted with dementia status and physician recommendations in hypothetical cases.
The researchers found that directives affected recommendations in both groups: life-sustaining care was recommended more often when a directive requested it and less often when it called for comfort-focused care. Yet participants were more likely to recommend life-sustaining treatment for patients without dementia across the reported directive scenarios. The research was published in JAMA Network Open in October 2026; the paper’s DOI is 10.1001/jamanetworkopen.2026.37691.
The report cites previous research suggesting that more than two-thirds of older adults may face a situation in which another person must make end-of-life medical decisions for them. That background underscores why documenting preferences and identifying a surrogate can matter, though the survey itself did not measure how common such planning is among its participants.
“People’s assumptions about what life is like with dementia appear to play an important role in how they think about treatment decisions.”
— Lauren Hersch Nicholas, lead author and professor of medicine at the University of Colorado Anschutz School of Medicine
As an affiliate, we earn on qualifying purchases.
Limits of the Survey Findings
The study measured participants’ recommendations in hypothetical scenarios, not decisions made at hospital bedsides. It does not establish whether the same patterns occur in clinical practice or how often a patient’s directive is followed in real cases. The supplied report also does not provide detailed participant demographics or enough information to determine how closely the sample reflects the U.S. population.
The reported findings identify differences in recommendations but do not establish the reasons behind every response. The authors point to assumptions about dementia and quality of life as a possible influence; that explanation should not be treated as a proven cause. The study also does not show that an advance directive alone can determine what care a patient will receive.
More detail about how physician recommendations affected responses, or how results varied across different participant groups, is not included in the available report. The findings therefore describe the survey’s overall patterns rather than every factor that may shape an individual decision.
As an affiliate, we earn on qualifying purchases.
Ongoing Planning and Patient Wishes
The report’s authors call for more sustained advance care planning, including conversations about what matters to patients and whether the person chosen as a surrogate understands those values. Nicholas said preferences should be revisited as health and circumstances change, rather than treated as a one-time paperwork task.
The study report does not announce a follow-up trial or a specific policy change. For now, the next step emphasized by the researchers is clearer communication between patients and potential decision-makers. Whether that approach changes recommendations in real clinical settings remains a question for further research.
As an affiliate, we earn on qualifying purchases.
Key Questions
What did the study find?
In a survey of nearly 6,000 U.S. adults, participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for one without dementia. The difference remained even when a directive requested life-sustaining care.
Did advance directives affect participants’ recommendations?
Yes. Participants more often recommended life-sustaining treatment when a directive requested it and less often when it requested comfort-focused care. The directive did not remove the difference associated with dementia status.
Were these actual medical decisions?
No. Participants responded to hypothetical scenarios in an online survey. The findings do not directly measure treatment decisions or outcomes in hospitals.
What did the researchers say patients can do?
The authors emphasized discussing care preferences with the person chosen to make decisions, explaining the values behind those preferences and revisiting the conversation as circumstances change. The study does not guarantee that such planning will produce a particular treatment decision.
Source: rss
Halloween Picks
halloween
As an affiliate, we earn on qualifying purchases.
