End of life treatment decisions in people with dementia: carers' views and the factors which influence them

Objective. Treatment decisions in life threatening situations (TD) are poorly studied in people with dementia.

Method. The carers of people with dementia were asked four TD questions, pertaining to cardiac resuscitation, intravenous fluids, oral antibiotics and intravenous antibiotics. The impact of key variables (age, dementia severity, psychiatric co-morbidity, physical illness, family relationship of carer) on TD were evaluated.

Results. Fifty carers participated, 46% wanted cardiac resuscitation, 60% wanted treatment with intravenous fluids, 52% wanted treatment with intravenous antibiotics and 60% wanted treatment with oral antibiotics. Agreement between questions was high (76 – 89%), suggesting that relatives were either for or against intervention. There was an association between more severe dementia and a reduced wish for intravenous antibiotics. None of the variables significantly influenced other TD.

Conclusion. The ‘global’ view of carers, was not influenced greatly by key disease variables. There are potential implications for the way in which carers are used as proxy decision makers. Copyright © 2000 John Wiley & Sons, Ltd.