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OBJECTIVE: This study examines the influence of cognitive impairment, premorbid intelligence, and decision-making capacity to complete advance directives on the treatment preferences for life-sustaining medical therapy in the elderly. METHOD: One hundred elderly individuals were recruited. Fifty were first referrals to specialist services with a DSM-IV diagnosis of dementia, and 50 were volunteers. Each person was asked about treatment preferences in three clinical vignettes. RESULTS: Elderly individuals who had cognitive impairment and were incapable of completing advance directives were significantly more likely to opt for life-sustaining interventions. There was no association between premorbid intelligence and treatment preferences. CONCLUSIONS: Cognitive impairment appears to influence treatment preferences for life-sustaining medical therapy. With increasing cognitive impairment, elderly individuals tend to opt for treatment interventions.

Original publication




Journal article


Am J Psychiatry

Publication Date





1009 - 1011


Advance Directives, Age Factors, Aged, Aged, 80 and over, Attitude to Health, Cognition Disorders, Comorbidity, Decision Making, Dementia, Female, Humans, Intelligence, Life Support Systems, Male, Middle Aged, Psychiatric Status Rating Scales