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Would Caregivers of Alzheimer Disease Patients Involve Their Relative in a Decision to Use an AD-Slowing Medication?

Received Aug. 30, 2004; revision received March 17, 2005; accepted May 4, 2005. From the School of Nursing, Division of Biobehavioral and Health Sciences (KBH), the Dept. of Sociology (CMJ), the Dept. of Medicine (BDJ, DJC, JHTK), the Division of Geriatrics (BDJ, DJC, JHTK), the Dept. of Biostatistics and Epidemiology (SXX), the Leonard Davis Institute of Health Economics (DJC, JHTK), the Center for Bioethics (DJC, JHTK), the Alzheimer’s Disease Center (SXX, JHTK), and The Institute on Aging (KBH, DJC, JHTK), at the Univ. of Pennsylvania and The Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (DJC). Send correspondence and reprint requests to Dr. Karen Hirschman, Institute on Aging, 3615 Chestnut Street, Philadelphia, PA 19104. e-mail: hirschk{at}nursing.upenn.edu
© 2005 American Association for Geriatric Psychiatry

Objectives: 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. Conclusion: 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.

Key Words: Alzheimer Disease • Family Caregivers • ACE Inhibitors

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