Which level of care is preferred for end-stage dementia? Survey of Taiwanese caregivers

In Western countries, most family caregivers view some degree of palliative care as appropriate for severely demented care recipients. In Asian countries, caregivers' attitudes toward such an important issue have not been sufficiently investigated. Therefore, we surveyed Taiwanese caregivers' attitudes toward the terminal care of demented care recipients by questionnaire. In 115 (48 men, 67 women; mean age 73.7 ± 9.5 years) caregivers who completed the questionnaire, most caregivers (61%) preferred highly aggressive care, whereas only 3% preferred solely palliative care at the end of the demented care recipients' life. Caregivers having a lower education level (≤ 12 vs > 12 years) or having care recipients of a younger age (≤75 vs >75 years) exhibited a higher preference for cardiopulmonary resuscitation (CPR) (P = .020 and P = .010, respectively). Sixteen percent of caregivers accepted postmortem autopsy for their care recipients. Twenty-eight percent of caregivers of home-resident recipients anticipated institutionalization, especially those with care recipients having moderate to severe stages of dementia. Co-surrogate caregivers, including the spouse and the offspring, were the most common proxies (39%) for care recipients with end-stage dementia. By comparison with Western countries, the low acceptance rate of CPR refusal and nursing home placement by our caregivers might result from cultural differences.