Impact of Cognitive Impairment on Treatment Preferences Among OAs

Cognitive impairment was correlated with greater uncertainty about treatment preferences and higher rates of aggressive care preferences among older adults (OAs) when compared to OAs with normal cognition. Researchers published their findings in Journal of the American Geriatrics Society.

Of the 1291 self-respondents from the 2018 Health and Retirement Study, 201 had cognitive impairment and 1090 had normal cognition. Treatment preferences for life-extending, limited, and comfort care options were examined utilizing 2 hypothetical clinical scenarios.

The respondents were asked to imagine a patient with (1) good physical health with severe cognitive impairment consistent with dementia; and (2) with physical impairment due to a heart attack, but normal cognition. They were then asked to determine whether they were unsure or if they would want or not want each treatment option.

“Respondents with cognitive impairment were more likely to report that they were unsure about treatment options across both clinical scenarios compared to those with normal cognition,” reported researchers.

Cognitive impairment was associated with a lower rate of expressing a treatment preference by 7.3 (P = .070) and 8.5 (P = .035) percentage points for dementia and heart attack scenarios, in the limited treatment option.

Cognitive impairment was also connected with a higher rate of preference for life-extending treatment in both dementia (30.1% vs 20.0%, P = .044) and heart attack scenarios (30.0% vs 20.2%, P = .033) for those who expressed preferences.

“Further research should assess whether preferences for aggressive care become more common as cognition declines in order to improve preference-concordant care delivery for patients with cognitive impairment,” concluded study authors.

Reference:
Owsley KM, Langa KM, Macis M, Nicholas LH. Treatment preferences among adults with normal cognition and cognitive impairment. J Am Geriatr Soc. Published online September 12, 2022. doi:10.1111/jgs.18032