• Patrick Triplett, Betty S Black, Hilary Phillips, Sarah Richardson Fahrendorf, Jack Schwartz, Andrew F Angelino, Danielle Anderson, and Peter V Rabins.
• Department of Psychiatry, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Meyer 279, 600 North Wolfe Street, Baltimore, MD 21287, USA. ptriple@jhmi.edu
• J Aging Health. 2008 Aug 1;20(5):583-96.

ObjectiveTo examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives.MethodThe documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed.ResultsMore years of education and White race were significantly associated with having an advance directive. With the exceptions of comfort care and pain treatment, advance directives were used primarily to restrict, not request, many forms of care at the end of life. Decisions about care for end-stage conditions such as Alzheimer's dementia are less often addressed in these documents than for terminal conditions and persistent vegetative state.DiscussionFor advance directives to better reflect a person's wishes, discussions with individuals and families about advance directives should include a range of care issues in the settings of terminal illness, persistent vegetative state or end-stage illness. These documents should be reviewed periodically to make certain that they convey accurately the person's treatment preferences.

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