It allows individuals to directly participate in decisions about their future care. If you are supporting someone in the later stages of dementia, discussing advance care planning with the person's family, healthcare provider, or another trusted friend can help you feel more supported in making decisions about the type of care and treatment the person would prefer.

Benefits of Advance Directives

Research has shown that advance directives can make a positive difference. People who document their preferences are more likely to receive the medical and comfort care they desire at the end of life. The two most common types of advance directives are the living will and the durable power of attorney for healthcare.

· Living Will: This document allows individuals to communicate how they want to be treated if they become unable to make their own decisions about emergency treatment. In a living will, you can specify which medical treatments or care you would want, which you would prefer to avoid, and under what circumstances each choice would apply.

· Durable Power of Attorney for Healthcare: This legal document names a healthcare proxy, a person who would make healthcare decisions for you if you were unable to communicate your wishes. Surrogate, also known as a representative,

surrogate, or agent, should be familiar with your values and preferences. A proxy can be chosen in addition to or instead of a living will.

What Happens Without an Advance Directive?

If you do not have an advance directive and are unable to make decisions on your own, state laws will determine who makes medical decisions for you. Typically, this will be your spouse, parents (if available), or adult children. If you are unmarried and have not named your partner as your proxy, it's possible they may be excluded from decision-making. If you have no family members, some states allow a close friend familiar with your values to help, or a physician may be assigned to represent your best interests. While it is impossible to predict the future, having an advance directive can provide you and those close to you with peace of mind. Remember, an advance directive is only used if you are unable to make decisions yourself.

Will Advance Directives Guarantee My Wishes Are Followed?

An advance directive is legally recognized but not legally binding. Healthcare providers and your proxy will do their best to respect your wishes, but there may be circumstances where they cannot follow them exactly. For example, in a complex medical situation, it may be unclear what you would want. This is why open and honest conversations about advance care planning are so important. They help your loved ones understand your values and preferences, enabling them to better navigate unexpected issues.

In some emergency situations, the healthcare team may not know your wishes before providing care. For instance, if you have a sudden heart attack and need an ambulance, first responders are unlikely to locate your advance directive or healthcare proxy before delivering care. For these scenarios, you can speak with your doctor about establishing out-of-hospital do not resuscitate orders (DNR) or portable medical orders, such as physician orders for life-sustaining treatment (POLST). These can help make your treatment preferences clear to health professionals during a medical emergency, whereas advance directives often guide treatment after a medical emergency.

There is also a possibility that a healthcare provider may refuse to follow your advance directive if it conflicts with their conscience, the institution’s policy, or accepted healthcare standards. In such cases, the provider must inform your healthcare proxy immediately and consider transferring your care to another provider.

Conclusion

Providing care for older adults involves assisting them in organizing their health, legal, and financial matters. For individuals with dementia, it is advisable to address these issues in

the early stages, ensuring that their preferences are clearly communicated and honored. While these discussions may be challenging, they are crucial. It is important to reassure the individual that they will continue to make their own decisions if they are capable.

Advance directives serve to alleviate stress and uncertainty for families during periods that can be both difficult and unpredictable. An advance directive offers guidance and support to loved ones, helping them to make decisions that respect the person's values and wishes.

Please consult with healthcare providers and legal professionals when making decisions regarding advance directives and future planning.

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Sheryl A. Oglesby is a certified dementia practitioner, certified Montessori dementia care professional and a certified dementia support group facilitator. For more information contact Mrs. Oglesby at leeleeoglesby@gmail.com or call 423-698-8086.