WEDNESDAY, Oct. 14, 2026 (HealthDay News) -- Surrogates are less likely to choose life-sustaining treatment (LST) for patients with versus those without dementia, even in the presence of an advance directive requesting LST, according to a study published online Oct. 7 in JAMA Network Open.
Lauren Hersch Nicholas, Ph.D., M.P.P., from the University of Colorado School of Medicine in Aurora, and colleagues examined how factors, including dementia, advance directives, clinical recommendations, and decision makers' values, are associated with participant treatment recommendations for seriously ill older adults in a survey study.
Overall, 5,965 individuals completed at least one vignette response, including 2,004 caregivers of an adult and 3,175 with chronic illness, a mobility limitation, and/or recent emergency or urgent care use. The researchers found that participants recommended that surrogates choose LSTs for 15.6, 41.0, and 7.6 percent of patients with dementia without an advance directive, with an advance directive requesting LSTs, and with an advance directive requesting comfort care only, respectively, when holding other randomized vignette features constant. For corresponding groups of patients without dementia, participants recommended that surrogates choose life-extending treatment for 38.9, 66.3, and 14.4 percent, respectively.
"Advance care planning isn't just about filling out a document and putting it in a drawer," Nicholas said in a statement. "It's about having ongoing conversations about what matters to you, making sure the person you've chosen as your surrogate understands those values and revisiting those conversations as your health and circumstances change."
