Helping patients communicate their wishes
Talking with your loved one about end-of-life issues might be sad and difficult. But it might also be one of the most important conversations you ever have – especially if you’re the caregiver for someone with dementia.
The Alzheimer’s Association recommends that your loved one make an advance directive as soon as possible after a diagnosis if he or she doesn’t already have one. An advance directive is a set of legal documents that outlines your loved one’s wishes regarding medical care in the event that they cannot make decisions for themselves – and helps you make sure that your loved one’s wishes are honored.
“It’s a good idea for people with memory problems to complete advance directive documents while they still have the ability to think clearly,” explains Vickie Armstrong, DNP. “They will need to make good judgements about medical and financial care, sign legal documents and communicate their wishes.”
The advance care directive goes into effect only if your loved one is incapacitated and can’t communicate with the doctor due to the dementia, illness or injury.
How to create an advance care directive
To create an advance directive, your loved one will need two written documents – a living will and a durable power of attorney.
1. A living will. This document specifies the type of emergency treatment your loved one would like if he or she is dying or permanently unconscious and can’t make decisions.
The National Institute on Aging suggests that a living will answer these questions:
- Would you like CPR, cardiopulmonary resuscitation, to restore your heartbeat if it stops beating or if it beats irregularly? During CPR, someone will push on the chest repeatedly while putting air into the lungs. Sometimes ribs are broken or a lung collapses in the process. Electric shocks, known as defibrillation, and medicines might also be used.
- Would you like the use of a ventilator to help you breathe? The ventilator forces air into your lungs via a special tube that is fed through your throat into your trachea.
- Would you like artificial nutrition via a feeding tube that is threaded through your nose into your stomach? Some doctors believe that assisted oral feeding by a caregiver is a less risky alternative for people with late-stage dementia.
- Would you like artificial hydration through an IV tube inserted into one of your veins?
- What type of comfort care would you like at the end of life? Caregivers can provide pain medication and help provide other types of physical, spiritual and emotional support.
2. Durable power of attorney/health care proxy. In this legal document, your loved one chooses a health care proxy – someone he or she trusts to make medical decisions and communicate on their behalf.
What happens if advance directives are not in place?
If your loved one does not have an advance directive or the directive does not address every issue that arises at the end of life, a physician or nurse may ask what you think your loved one would want. To answer this question, consider this person’s beliefs and values and how he or she has made decisions in the past. As a caregiver, you’ll know that you’ve done all you can to respect your loved one’s wishes.
For more information about advance directives, visit Five Wishes.
For more advice on caring for someone with memory loss or dementia, contact the Riverside Memory Care Program or the Riverside Center for Excellence in Aging and Lifelong Health or call 757-220-4751.
