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In a randomized survey of nearly 6,000 U.S. adults, participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for one without dementia. Advance directives requesting treatment raised recommendations in both groups, while the preferences of the surrogate decision-maker also influenced choices.
Adults taking part in a survey were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for a patient without dementia, even when an advance directive requested treatment, according to research from the University of Colorado Anschutz. The findings, published in JAMA Network Open, suggest that a patient’s diagnosis may shape surrogate-style decisions alongside documented wishes and a physician’s recommendation.
The researchers surveyed nearly 6,000 U.S. adults in a randomized online experiment. Participants considered scenarios involving seriously ill, hospitalized older adults. The researchers varied whether the patient had dementia, whether an advance directive called for life-sustaining or comfort-focused care, and whether a physician recommended treatment. The scenarios measured participants’ recommendations; they were not records of actual clinical decisions or treatment delivered to patients.
For patients with dementia and no advance directive, participants recommended life-sustaining treatment in 15.6% of scenarios. That share was 41.0% when the directive requested life-sustaining treatment and 7.6% when it requested comfort-focused care. For patients without dementia, the corresponding figures were 38.9%, 66.3% and 14.4%.
The study found a similar influence from directives in both groups, but participants recommended life-sustaining treatment more often overall for patients without dementia. The researchers also found that the preferences of the person making decisions on the patient’s behalf affected recommendations. The report does not say that any single factor determined every response.
How Dementia Shaped Treatment Choices
The results matter because advance directives may not, by themselves, settle how others interpret a patient’s wishes. If a person later cannot communicate, a surrogate may be asked to make decisions under difficult circumstances. The survey indicates that views about dementia can influence how people weigh treatment, even when a patient’s stated preference is available.
That is a concern for people who want their choices respected, but the findings should be read within the study’s limits: participants made recommendations in hypothetical scenarios. The survey does not establish how frequently real surrogates depart from directives, whether clinicians follow those recommendations, or how the decisions affect patient outcomes. It does highlight why understanding the person’s values—and communicating them to a chosen decision-maker—can matter beyond completing paperwork.
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Directives and Surrogate Decisions
An advance directive records preferences for future medical care if someone becomes unable to communicate or make decisions. A surrogate decision-maker is someone authorized or asked to make health care choices for a patient who cannot make or communicate them. In the scenarios, directives calling for life-sustaining care were associated with more recommendations for that care, while comfort-focused directives were associated with fewer.
The report cites prior research suggesting that more than two-thirds of older adults may encounter a situation in which another person needs to make end-of-life medical decisions for them. It also says many older adults have not designated a surrogate or documented their preferences. Those figures are cited as background, not findings from the new survey.
Lead author Lauren Hersch Nicholas, a professor of medicine in the University of Colorado Anschutz School of Medicine’s division of geriatric medicine, said the study points to the influence of people’s assumptions about life with dementia. The research was published in JAMA Network Open and is identified in the report by DOI 10.1001/jamanetworkopen.2026.37691.
“People’s assumptions about what life is like with dementia appear to play an important role in how they think about treatment decisions.”
— Lauren Hersch Nicholas, study lead author
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Limits of the Survey Evidence
The findings describe responses to hypothetical cases, not observed treatment decisions in hospitals. The report does not establish why participants gave different recommendations, how closely survey responses predict real-world surrogate behavior, or whether the results apply equally across patient populations and clinical settings. It also does not provide evidence that a particular type of advance-care conversation changes actual treatment or patient outcomes.
The study’s headline difference is reported as about 19 percentage points, but the supplied report does not specify the exact comparison calculation or its uncertainty interval. The scenario percentages provide additional detail but should not be treated as rates of care in the general population. The report gives no follow-up findings on how participants might respond after discussion with a patient or clinician.
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The Case for Ongoing Planning
The study report does not announce a next research milestone or planned follow-up. Its authors argue for more sustained advance-care planning: documenting preferences, talking through what matters with the chosen surrogate, and revisiting those discussions as health or circumstances change. The results do not prescribe a specific medical choice; they point to communication as an issue for patients, families and care teams.
Further research would be needed to test whether these survey patterns appear in real clinical decisions and whether particular planning approaches help surrogates interpret patients’ wishes. For now, the study offers evidence about how dementia status, written directives and decision-makers’ own preferences shaped recommendations in the scenarios presented.
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Key Questions
What did the survey find?
Participants were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for one without dementia, including when a directive requested treatment. The survey measured hypothetical recommendations, not actual care.
Did advance directives affect recommendations?
Yes. For patients with dementia, participants recommended life-sustaining treatment in 15.6% of scenarios without a directive, compared with 41.0% when a directive requested it. A comfort-focused directive corresponded with a 7.6% recommendation rate.
Who conducted the research?
Researchers from the University of Colorado Anschutz surveyed nearly 6,000 U.S. adults. The study was published in JAMA Network Open in October 2026.
Does the study show what happens in hospitals?
No. Participants responded to randomized online scenarios. The study does not establish how often real surrogates make similar choices or what care patients ultimately receive.
What do the researchers say people should take from the findings?
Lead author Lauren Hersch Nicholas said advance-care planning involves more than completing a form: people can discuss their values with the person they choose to make decisions and revisit those conversations as circumstances change.
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