Effect of cognitive impairment and premorbid intelligence on treatment preferences for life-sustaining medical therapy.
OBJECTIVE
This study examines the influence of cognitive impairment, premorbid intelligence, and decision-making capacity to complete advance directives on the treatment preferences for life-sustaining medical therapy in the elderly.


METHODS
One hundred elderly individuals were recruited. Fifty were first referrals to specialist services with a DSM-IV diagnosis of dementia, and 50 were volunteers. Each person was asked about treatment preferences in three clinical vignettes.


RESULTS
Elderly individuals who had cognitive impairment and were incapable of completing advance directives were significantly more likely to opt for life-sustaining interventions. There was no association between premorbid intelligence and treatment preferences.


CONCLUSIONS
Cognitive impairment appears to influence treatment preferences for life-sustaining medical therapy. With increasing cognitive impairment, elderly individuals tend to opt for treatment interventions.
Fazel
S
S
Section of Old Age Psychiatry, Department of Psychiatry, University of Oxford, Warneford Hospital, UK. seena.fazel@psych.ox.ac.uk
Hope
T
T
Jacoby
R
R
D016223:Advance Directives; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003657:Decision Making; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007360:Intelligence / Q000145:classification*; D008021:Life Support Systems / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data