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Impact of brief education on healthy seniors’ attitudes and healthcare choices about Alzheimer's disease and associated symptoms

  • Robyn E. Waxman (a1) (a2) (a3), Barbara J. Russell (a1) (a2) (a4), Oscar C. T. Iu (a2) and Benoit H. Mulsant (a1) (a2)



The primary objective of this study was to determine whether a brief education session about Alzheimer's disease (AD) stages and associated behavioral and psychological symptoms of dementia (BPSD) changes healthy seniors’ treatment choices. A secondary objective was to determine whether pharmacotherapy to reduce BPSD would be preferred over other potentially more restrictive interventions.


Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session.


Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints.


Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.


Corresponding author

Correspondence should be addressed to: Robyn E. Waxman, Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 5S9, Canada. Phone: +(416) 450-1330; Fax: +(905) 430-4465. Email:


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Aleccia, J. (2017). End-of-life Advice: More than 500,000 Chat on Medicare's Dime. Kaiser Health News. 14 August 2017. Available at:; last accessed 22 August 2017.
Arai, Y., Arai, A. and Zarit, S. (2008). What do we know about dementia?: a survey on knowledge about dementia in the general public of Japan. International Journal of Geriatric Psychiatry, 23, 433438.
Boustani, M. et al. (2008). Measuring primary care patients’ attitudes about dementia screening. International Journal of Geriatric Psychiatry, 23, 812820.
Carpenter, B. et al. (2009). The Alzheimer's disease knowledge scale: development and psychometric properties. Gerontologist, 49, 236247.
Deep, K. et al. (2010). “It helps me see with my heart”: how video informs patients’ rationale for decisions about future care in advanced dementia. Patient Education and Counseling, 81, 229234.
Fried, T. R. et al. (2011). Agreement between older persons and their surrogate decision-makers regarding participation in advance care planning. Journal of American Geriatrics Society, 59, 11051109.
Gjerdingen, D. et al. (1999). Older persons’ opinions about life-sustaining procedures in the face of dementia. Archives of Family Medicine, 8, 421425.
Hamann, J. et al. (2010). Can psychiatrists and neurologists predict their patients' participation preferences? Journal of Nervous and Mental Disease, 198, 309311.
Hersch, E. C. and Falzgraf, S. (2007). Management of the behavioral and psychological symptoms of dementia. Clinical Interventions in Aging, 2, 611621.
Janz, N. K. and Becker, M. H. (1984). Health belief model: a decade later. Health Education Quarterly, 11, 147.
Kim, H. M., Chiang, C. and Kales, H. C. (2011). After the black box warning: predictors of psychotropic treatment choices for older patients with dementia. Psychiatric Services, 62, 12071214.
Kolanowski, A. et al. (2010). It's about time: use of nonpharmacological interventions in the nursing home. Journal of Nursing Scholarship, 42, 214222.
Krueger, R. A. and Casey, M. A. (2000). Focus Groups: A Practical Guide for Applied Research. Thousand Oaks: Sage Publications.
Leone, E. et al. (2009). Methodological issues in the non-pharmacological treatment of BPSD in nursing home—the TNM study. Journal of Nutrition Health and Ageing, 13, 260263.
Lyketsos, C. B. et al. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 14751483.
Madhusoodanan, S. (2001). Introduction: antipsychotic treatment of behavioural and psychological symptoms of dementia in geropsychiatric patients. American Journal of Geriatric Psychiatry, 9, 283288.
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 3944.
Morrison, R. S. and Siu, A. L. (2000). Survival in end-stage dementia following acute illness. JAMA, 284, 4752.
Narang, P. et al. (2010). Antipsychotic drugs: sudden cardiac death among elderly patients. Psychiatry, 7, 2529.
National Cancer Institute (2011). Theory at a Glance: A Guide for Health Promotion Practice: Health Belief Model. Available at:; last accessed November 22, 2011.
Onwuegbuzie, A. J. et al. (2009). A qualitative framework for collecting and analyzing data in focus group research. International Journal of Qualitative Methods, 8, 121.
Rurup, M. L. et al. (2005). Physicians’ experiences with demented patients with advance euthanasia directives in the Netherlands. Journal of American Geriatric Society, 53, 11381144.
Shalowitz, D. I., Garrett-Mayer, E. and Wendler, D. (2006). The accuracy of surrogate decision makers: a systematic review. Archives of Internal Medicine, 166, 493497.
Stevens, J. R. et al. (2014). Strategies for the prescription of psychotropic drugs with black box warnings. Psychosomatics, 55, 123133.
Thies, W and Bleil, L. (2013). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 9, 208245.
Uhlmann, R. F., Pearlman, R. A. and Cain, K. C. (1988). Physician’ and spouses’ predictions of elderly patients’ resuscitation preferences. Journal of Gerontology, 43, M115–121.
Volandes, A. E. et al. (2007). Using video images of dementia in advance care planning. Archives of Internal Medicine, 167, 828833.
Yung, V. Y. et al. (2010). Documentation of advance care planning for community-dwelling elders. Journal of Palliative Medicine, 13, 861867.


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