title: Would caregivers of Alzheimer disease patients involve their relative in a decision to use an AD-slowing medication?
abstract: OBJECTIVE
  The authors examined the factors associated with 1) caregivers' willingness to involve a relative with Alzheimer disease (AD) in a decision to use an AD-slowing treatment; and 2) how caregivers would resolve a disagreement over this decision with the their relative.
  
  
  METHODS
  This was a cross-sectional interview study of 102 caregivers of patients with mild-to-severe-stage AD, enrolled in a University Memory Disorders Clinic.
  
  
  RESULTS
  Forty-four percent of caregivers (45/102) said that his or her relative would participate in a decision to use an AD-slowing treatment. Logistic regression showed that having less dementia severity, being a female caregiver, and a spousal relationship were all associated with caregivers' involving their relative in this decision. Among the caregivers who said they would involve their relative, the majority said they would resolve disagreements over whether to use the treatment in favor of what the patient wanted, versus what the family wanted for the patient. Male caregivers were less likely to resolve disagreements in favor of the patients' preferences.
  
  
  CONCLUSIONS
  Although most caregivers of patients in mild-to-moderate stages would include these patients in an AD treatment decision, certain caregiver characteristics, such as gender and relationship, are associated with not involving patients in this decision. Physicians working with dementia patients and their family members should take these characteristics into account when discussing treatment options and work with patient-caregiver dyads to improve the communication of preferences.
authors.affiliation: Division of Biobehavioral and Health Sciences, The Univ. of Pennsylvania, School of Nursing, Philadelphia, PA, USA. hirschk@nursing.upenn.edu
authors.forename: Karen B
authors.initials: KB
authors.lastname: Hirschman
authors.forename: Colette M
authors.initials: CM
authors.lastname: Joyce
authors.forename: Bryan D
authors.initials: BD
authors.lastname: James
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Xie
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
authors.forename: Jason H T
authors.initials: JH
authors.lastname: Karlawish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D017028:Caregivers / Q000523:psychology*; D003220:Conflict, Psychological; D017281:Cost of Illness; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011368:Professional-Family Relations; D012642:Selegiline / Q000627:therapeutic use*; D018454:Spouses / Q000523:psychology; D024502:alpha-Tocopherol / Q000627:therapeutic use*
chemical_list: D012642:Selegiline; D024502:alpha-Tocopherol