In 1991, the New Jersey Legislature passed the New Jersey Advance Directives for Health Care Act. We surveyed the elderly about their knowledge and interest in advance directives, their preferences regarding end-of-life care, and whether their physicians discuss these matters.
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Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective.
J Med Ethics
January 2025
Medicine for Older People, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands.
Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases.
View Article and Find Full Text PDFNavigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives.
Nurs Philos
January 2025
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia.
View Article and Find Full Text PDFDespite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol.
View Article and Find Full Text PDFGeriatrics-Focused vs Traditional Primary Care in the Veterans Affairs Health Care System.
JAMA Netw Open
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Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina.
Importance: Older adults often require specialized health care expertise, but the effects of geriatrics-focused models of primary care have not been fully evaluated.
Objective: To compare the effects of geriatrics-focused primary care vs traditional primary care for older patients in the Veterans Affairs (VA) health care system.
Design, Setting, And Participants: In this cohort study, geriatrics-focused primary care and traditional primary care patient dyads matched on variables associated with geriatrics-focused primary care entry and outcomes were enrolled from VA medical centers with operational geriatrics-focused primary care clinics serving 500 or more patients annually in fiscal year 2016.
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