Pittsburgh Post-Gazette: How Can Seniors With Cognitive Impairment Keep Their Independence?

From The Pittsburgh Post-Gazette: America’s population is aging. The U.S. Census Bureau predicts that, by 2034, there will be more adults over 65 than children, and The Administration for Community Living projects the number of seniors over 85 will double between 2020 and 2040. With that shift will come more people than ever being diagnosed with dementia and cognitive impairment-causing conditions such as Alzheimer’s disease. Nearly one out of every three seniors over the age of 85 has Alzheimer’s dementia, and the annual incidence of Alzheimer’s is projected to double by 2050. These conditions cause a person’s decision-making abilities to deteriorate, making it increasingly difficult to manage personal, financial and health care affairs independently. In these cases, legal interventions — often in the form of full or partial guardianships — can come into play. But a growing number of physicians, lawyers and policymakers are bringing attention to how drastic legal action such as guardianships can put seniors’ livelihood and well-being at stake, and they’re pushing for less restrictive alternatives. One of those alternatives is a framework called supported decision-making. “When I think about something like Alzheimer’s disease, I think of it as a disease of autonomy,” says Emily Largent, a professor of medical ethics and health policy at the University of Pennsylvania and proponent of supported decision-making. “It affects people’s ability to make decisions about what’s important to them,” she continues. “One of my big concerns is that when we look at tools like guardianship, we’re stripping people of decision-making authority prematurely.” She explains that, in supported decision-making, an adult with cognitive impairment relies on a trusted person or group to assist them through choices around finances, health care, housing or any other complex issues in their lives. It can include assistance in understanding information, communicating preferences, exploring alternatives and considering potential consequences. Supporters may include family members, friends, advocates or professionals who work collaboratively with the person to enable them to exercise their decision-making autonomy. The process emphasizes that, at the end of the day, it’s the individuals’ decision, rather than a guardian’s. “Even though somebody’s helping them, they retain the power over their own life,” says Largent. The framework also lies in contrast to surrogate decision-making, an alternative to guardianship in which someone is authorized to make decisions on behalf of another person deemed incapable of making those decisions themselves. Read more at The Pittsburgh Post-Gazette.