Graduate (MSc) Student University of Toronto Brampton, Ontario
Abstract: Dementia is a growing public health challenge, affecting millions of individuals and their families worldwide. Dementia-specific advance directives (ADs) and surrogate decision-makers (SDMs) are essential in dementia care, ensuring that decisions align with the evolving preferences and needs of people living with dementia (PLWD). This study is based on a literature review consisting of ethical considerations of ADs, qualitative research studies, and narrative ethics, which informed the development of four key recommendations to improve the implementation of ADs. First, flexible ADs should be adopted, encouraging patients to continuously update their AD as their needs and preferences evolve. Second, communication should be enhanced through regular check-ins between healthcare providers, PLWD, and SDMs to ensure that care remains aligned with the PLWD’s evolving values and needs. Third, SDMs should be supported through training and resources on using ADs and substituted judgment. Finally, cultural sensitivity must be promoted by recognizing and integrating cultural values into ADs, particularly for ethno-racial minority populations, such as the Hispanic or South Asian community, where there is lower usage of ADs due to a lack of awareness and stigma. These ADs should reflect cultural values and be translated into different languages. The recommendations aim to address ethical concerns in dementia care, particularly when SDMs face challenges in making decisions due to cognitive decline in PLWD, which impairs their ability to communicate preferences. By integrating these four recommendations, this approach can enhance the decision-making process for SDMs, ensuring that care aligns with the evolving preferences of PLWD.
After participating in this conference, attendees should be able to:
At the end of this session, attendees will be able to analyze the challenges faced by surrogate decision-makers in dementia care and how flexible advance directives can address these challenges.
At the end of this session, attendees will be able to evaluate the importance of involving surrogate decision-makers in the creation of advance directives to improve decision-making in dementia care.
At the end of this session, attendees will be able to assess how culturally sensitive advance directives can enhance decision-making and ensure alignment with the values of diverse populations.
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