Decision making on behalf of elders with advanced cognitive impairment: family transitions

Changes in family decision making responsibilities occur with progression of cognitive impairment. Focus groups with family members of nursing home residents with advanced cognitive impairment investigated values and beliefs used in making decisions for the elder. Family members described difficult decisions they had made to date, noting a significant transition in their decision making role when the elders' decisions needed to be superseded (especially with changes in living arrangements). In most families, one person or couple assumed the principal decision making responsibility. When decisions were made in the context of family conflict, managing the conflict became the focus, rather than the elder's care. In such cases, the elder's previously stated wishes regarding end of life care were not as likely to be honored.