PRESERVING AUTONOMY IN EARLY-STAGE DEMENTIA

This article is limited to examining the question of the dementia patient's autonomy or self-determination in the context of offering advice and guidance to individuals with impaired cognitive functioning but who retain the capacity to make some judgments and decisions about the future. Autonomy will be defined, for our purposes, as independence and decision-making power. The means by which an individual may maintain some control and influence over future decisions relating to his health care by utilizing advance directives, will be discussed. These methods include durable power of attorney for health care and living wills. This article describes the health care planning and legal arrangements initiated by 332 individuals presenting at an out-patient dementia clinic for an initial assessment and the changes initiated by 115 of these patients who returned for a follow-up visit. Recommendations are made to social workers and other health care professionals to advise early-stage dementia patients to maintain more control over their remaining years by engaging in decision making about their future while they still have the capacity to do so. This should include planning for their health care by indicating their preferences for treatment or non-treatment in specific instances.