title: Gender-dependence of substituted judgment on quality of life in patients with dementia.
abstract: BACKGROUND
  Substituted judgment asks the proxy to decide what the patient would have decided, had he or she been competent. It is unclear whether substituted judgment of the patient's quality of life can serve as a surrogate measure in patients with dementia.
  
  
  METHODS
  212 patients with dementia and their proxies were interviewed in their homes. Dementia syndrome was characterized with cognitive, non-cognitive and functional scales. Quality of life (QoL) was assessed with the QoL-AD.
  
  
  RESULTS
  Substituted judgment of the patient's QoL was unrelated to dementia severity but also correlated with the proxie's own QoL (r = 0.356; p < 0.001). Gender-specific analysis reveals that for male proxies the most important variable is severity of patient's depression (r = -0.895; p = 0.001) while for female proxies it is the proxie's own QoL (r = 0.371; p < 0.001). Subjective burden correlates with the proxie's QoL in females (r = -0.282; p = 0.001) but not in males (r = -0.163, p = 0.161).
  
  
  CONCLUSIONS
  Substituted judgment of the patient's QoL does not correlate with dementia severity. Substituted judgment is subject to proxy-related variables in a gender-dependent fashion and therefore not suited to serve as an appropriate surrogate of the patients' quality of life.
authors.affiliation: Department of Psychiatry and Psychotherapy II, Mental Health & Old Age Psychiatry, Ulm University, Ulm, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schiffczyk
authors.forename: Christina
authors.initials: C
authors.lastname: Jonas
authors.forename: Constanze
authors.initials: C
authors.lastname: Lahmeyer
authors.forename: Friedemann
authors.initials: F
authors.lastname: Müller
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Riepe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D019727:Proxy / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D012647:Self-Assessment; D012720:Severity of Illness Index; D012727:Sex Characteristics