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Social determinants of health and mild cognitive impairment in a diverse community sample.
J Am Geriatr Soc
November 2024
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Background: The associations between community-wide social determinants of health and mild cognitive impairment (MCI) among individuals warrant investigation.
Methods: Among 2830 dementia-free individuals aged 65+ years in a community-based US study, we examined cross-sectional associations of MCI (Clinical Dementia Rating = 0.5) with the following potential social determinants of health: at the census tract or block group level obtained from public sources: neighborhood disadvantage (Area Deprivation Index, ADI), air pollution with fine particulate matter (PM), greenspace, Walkability Index, ambulatory healthcare availability per square mile, homicide rate; and at the individual participant level, birth/schooling in a southern US state.
A qualitative focus group study on legal experts' views regarding euthanasia requests based on an advance euthanasia directive.
BMC Med Ethics
October 2024
Department of Medicine for Older People, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Background: The Dutch Euthanasia law permits euthanasia in patients with advanced dementia lacking decisional capacity based on advance euthanasia directives. Nevertheless, physicians encounter difficulties assessing the criteria for due care in such cases. This study explores the perspectives of legal experts on the fulfillment of these criteria and the potential for additional legal guidance to support physicians' decision-making processes.
View Article and Find Full Text PDFNavigating Dilemmas on Advance Euthanasia Directives of Patients with Advanced Dementia.
J Am Med Dir Assoc
December 2024
Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Faculty of Medicine, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands.
Article Synopsis
- The study investigates the challenges that physicians in the Netherlands face when considering euthanasia requests from patients with advanced dementia, focusing on ethical dilemmas related to communication and assessing suffering.
- It involves a descriptive multimethod approach, including a questionnaire to gather insights from three categories of physicians: older adult care physicians (ECPs), support and consultation on euthanasia (SCEN) physicians, and euthanasia expertise center (EEC) physicians.
- Results revealed that while ECPs handle most requests for euthanasia based on advance directives, very few actually perform the procedure, with a consensus among all physician groups emphasizing the need for effective communication with patients to understand their wishes and gauge their suffering.
[Euthanasia in an advanced state of dementia: a verdict and its reception in the medical world].
Ned Tijdschr Geneeskd
August 2024
Universiteit van Amsterdam, faculteit Geesteswetenschappen, afd. Wijsbegeerte, Amsterdam.
The most controversial issue in the Dutch euthanasia practice concerns the performance of euthanasia in a case of a patient in an advanced state of dementia on the basis of a request that is laid down in an advance directive. This is particularly controversial when such a patient, although lacking decisional capacity on the matter, shows signs of a wish to live. In two important verdicts of April 21 2020 the Dutch Supreme Court has ruled that a request that has been made competently cannot be revoked incompetently.
View Article and Find Full Text PDFDenial of Desire for Death in Dementia: Why Is Dementia Excluded from Australian Voluntary Assisted Dying Legislation?
J Law Med
June 2024
Clinical Neuropsychologist, Newcastle Neuropsychology and Juris Doctor/Diploma of Legal Practice Candidate, University of Newcastle.
Euthanasia in the form of Voluntary Assisted Dying (VAD) is legal in all Australian States, but current eligibility criteria preclude access to people with dementia. This article discusses Australian VAD eligibility criteria that are problematic for people with dementia: (1) time until death within 12 months, (2) decision-making capacity for VAD, and (3) determination of intolerable suffering. Legislation in the Netherlands allows VAD for people with dementia.
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