The Association Between Mild Cognitive Impairment Diagnosis and Patient Treatment Preferences: a Survey of Older Adults

Levine, Deborah A.; Gałecki, Andrzej T.; Plassman, Brenda L.; Fagerlin, Angela; Wallner, Lauren P.; Langa, Kenneth M.; Whitney, Rachael; Nallamothu, Brahmajee K.; Morgenstern, Lewis B.; Reale, Bailey K; Blair, Emilie M; Giordani, Bruno; Welsh‐Bohmer, Kathleen A.; Kabeto, Mohammed U.; Zahuranec, Darin B.

doi:10.1007/s11606-021-06839-w

Cited by 6 publications

(4 citation statements)

References 47 publications

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“…Some providers may assume that patients with cognitive impairment prefer less treatment due to perceived lower life expectancy or worsened quality of life 35 . However, our findings are consistent with previous studies suggesting that those with cognitive impairment do not prefer fewer life‐extending treatments 23 . Education efforts may be necessary to improve providers' understanding of cognitive impairment prognosis and treatment preferences associated with cognitive impairment.…”

Section: Discussionsupporting

confidence: 85%

“…35 However, our findings are consistent with previous studies suggesting that those with cognitive impairment do not prefer fewer life-extending treatments. 23 Education efforts may be necessary to improve providers' understanding of cognitive impairment prognosis and treatment preferences associated with cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…academic medical centers. 23 We build on this work using new, nationally-representative survey data from the Health and Retirement Study.…”

Section: Why Does This Paper Matter?mentioning

confidence: 99%

“…How treatment preferences vary by cognitive status is largely unknown. A recent study found that individuals with MCI express no difference in life‐extending treatment preferences compared to those with normal cognition; however, the study included only 66 participants with MCI that were recruited from two academic medical centers 23 . We build on this work using new, nationally‐representative survey data from the Health and Retirement Study.…”

Section: Introductionmentioning

confidence: 99%

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Treatment preferences among adults with normal cognition and cognitive impairment

Owsley

Langa

Macis

et al. 2022

J American Geriatrics Society

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Background: Although patient participation in treatment decisions is important for preference-concordant care delivery, it is largely unknown how cognitive impairment influences treatment preferences. We investigated whether treatment preferences for the care of serious illness differ between adults with and without cognitive impairment in hypothetical clinical scenarios.Methods: Data from the 2018 Health and Retirement Study were used. The sample included 1291 self-respondents (201 respondents with cognitive impairment, and 1090 with normal cognition). We examined treatment preferences for life-extending, limited, and comfort care options in two hypothetical clinical scenarios where the respondent imagines a patient with (1) good physical health with severe cognitive impairment consistent with dementia; and (2) with physical impairment due to a heart attack, but normal cognition. Respondents specified whether they were unsure, or if they would want or not want each treatment option. Linear probability models were used to compare treatment preferences by cognitive status.Results: Respondents with cognitive impairment were more likely to report that they were unsure about treatment options across both clinical scenarios compared to those with normal cognition. For the limited treatment option, cognitive impairment was associated with a lower rate of expressing a treatment preference by 7.3 (p = 0.070) and 8.5 (p = 0.035) percentage points for dementia and heart attack scenarios, respectively. Among those who articulated preferences, cognitive impairment was associated with a higher rate of preference for life-extending treatment in both dementia (30.1% vs. 20.0%, p = 0.044) and heart attack scenarios (30.0% vs. 20.2%, p = 0.033).Conclusions: Compared to those with normal cognition, cognitive impairment was associated with greater uncertainty about treatment preferences and higher rates of aggressive care preferences among those who specified preferences. Further research should assess whether preferences for aggressive care become more common as cognition declines in order to improve preferenceconcordant care delivery for patients with cognitive impairment.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

“…academic medical centers. 23 We build on this work using new, nationally-representative survey data from the Health and Retirement Study.…”

Section: Why Does This Paper Matter?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations