TL;DR
Get oils, diffusers and self-care 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 less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for one without dementia. An advance directive requesting treatment raised recommendations in both groups, but did not erase the difference.
A survey experiment involving nearly 6,000 U.S. adults found participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for a patient without dementia, even when a directive documented a wish for treatment. The University of Colorado Anschutz researchers said the findings suggest a patient’s dementia status and a surrogate’s own preferences may shape recommendations alongside written instructions.
The study, published in JAMA Network Open, presented participants with scenarios about seriously ill, hospitalized older adults. Researchers varied whether the patient had dementia, whether an advance directive called for life-sustaining or comfort-focused care, and whether a physician recommended treatment. The survey measured participants’ recommendations in those hypothetical situations; it did not track actual clinical decisions or patient outcomes.
For patients with dementia and no advance directive, participants recommended life-sustaining treatment in 15.6% of scenarios. That share was 41.0% when the directive requested life-sustaining treatment, and 7.6% when the directive requested comfort-focused care. For patients without dementia, the corresponding figures were 38.9%, 66.3% and 14.4%.
The results show that directives influenced recommendations in both groups, while the gap associated with dementia remained. The study also found that the preferences of the person acting as surrogate mattered. Lead author Lauren Hersch Nicholas, a professor of medicine at the University of Colorado Anschutz School of Medicine, said both a clear statement of wishes and the decision-maker’s preferences affected responses.
Written Wishes Did Not Remove the Gap
The findings matter because people who cannot communicate may depend on a surrogate decision-maker to interpret their wishes. In the scenarios, a directive requesting treatment made participants more likely to recommend it, but the patient’s dementia status still influenced recommendations. That raises a practical concern: a written preference may not, by itself, determine how another person weighs treatment options.
The survey does not establish that people with dementia receive less life-sustaining care in hospitals, or explain how any individual surrogate would act in a real emergency. It does, however, show how views about dementia can enter hypothetical decisions, even when a patient’s stated preference is available. The researchers argue that advance planning should include discussion with the chosen decision-maker, not only completion of a document.
For patients and families, the distinction is relevant when planning for a time a person may be unable to speak for themselves. Sharing what matters, discussing how preferences might apply in different circumstances and checking that a surrogate understands those values may help clarify the role the patient wants that person to play.
How Directives and Surrogates Were Tested
An advance directive records a person’s preferences for future medical care if they cannot communicate or make decisions. A surrogate is someone asked or authorized to make health care decisions on the patient’s behalf when the patient cannot do so. The survey compared scenarios with directives for life-sustaining care, directives for comfort-focused care, and no directive.
The research was a randomized online survey experiment, not a review of medical records or a clinical trial. Participants responded to constructed cases, allowing researchers to compare how specific details affected recommendations. The study was led by Lauren Hersch Nicholas and published in 2026 in JAMA Network Open; its DOI is 10.1001/jamanetworkopen.2026.37691.
The researchers cited prior work suggesting that more than two-thirds of older adults may face a situation in which someone else must make end-of-life medical decisions for them. That figure is background cited in the report, not an estimate produced by this survey. The authors say many people have not designated a surrogate or recorded their preferences.
“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, study lead author and professor of medicine at the University of Colorado Anschutz School of Medicine
Survey Responses Are Not Hospital Decisions
The findings concern recommendations in hypothetical cases. They do not show what participants would do as actual surrogates, what clinicians would recommend in a specific case, or what treatment patients with dementia receive in practice. The report also does not establish why dementia status changed responses; the authors point to assumptions about quality of life as a possible influence.
The supplied study summary does not provide further detail about how responses varied by participant characteristics, how the physician recommendation affected each result, or whether the findings generalize beyond the survey sample. The reported percentages describe scenarios in the experiment and should not be read as rates of treatment in hospitals.
Researchers Call for Ongoing Planning
Nicholas and her colleagues call for more sustained advance care planning, including conversations about a person’s values and whether the chosen surrogate understands them. The study does not announce a new policy or clinical guideline. Its immediate implication, according to the researchers, is that asking whether someone has a directive may be insufficient without discussing what it means and who will act on it.
Further research would be needed to determine whether the patterns seen in hypothetical recommendations also appear in real-world care and how communication between patients, families and clinicians affects decisions. For now, the authors’ recommendation is to revisit care preferences as health and circumstances change and to make sure a selected decision-maker knows the patient’s wishes.
Key Questions
What did the survey find about dementia and life-sustaining treatment?
Participants were about 19 percentage points less likely to recommend life-sustaining treatment in scenarios involving a seriously ill patient with dementia than in scenarios involving a patient without dementia, including when a directive requested treatment.
Did an advance directive affect participants’ recommendations?
Yes. For patients with dementia, recommendations for life-sustaining treatment were 15.6% of scenarios with no directive, 41.0% when a directive requested treatment and 7.6% when it requested comfort-focused care. The directive also affected responses for patients without dementia.
Does the study show that hospitals provide less treatment to patients with dementia?
No. The study measured responses to hypothetical scenarios, not actual hospital care, clinical decisions or patient outcomes.
What do the researchers say people should do when planning care?
The authors recommend discussing care preferences with the person who may serve as surrogate, making sure that person understands the patient’s values, and revisiting those conversations as circumstances change.
Source: rss
Halloween Picks
halloween
As an affiliate, we earn on qualifying purchases.
