Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making.  In a national survey, Lauren Hersch Nicholas, PhD, and co-authors found participants were more likely to indicate that surrogates should choose comfort care when a hospitalized older adult has dementia, even when the patient’s advance directives indicated s/he would prefer life-extending treatments. 

Conversely, for hypothetical patients without dementia, respondents are more likely to state that the surrogate should choose life-extending treatments even when the patient had indicated s/he would want comfort care.  Their findings suggest that older adults should choose proxy decision-makers with similar preferences to their own to increase preference-concordant surrogate decisions. 
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