Pictures Speak Louder than Words

All religious beliefs aside, medical and legal experts counsel individuals to create living wills and advance health care directives and to name health care proxies before we actually need them. Doing so can save immeasurable pain and heartache for your loved ones if you are incapacitated. Now, new research reports that when people view videos of patients in such a state, it helps provide a better understanding of the reality of what those final days might look and feel like for all involved… which in turn helps people decide about the level of care they’d like to receive if and when they fall ill.

Pictures Speak Louder than Words

At Massachusetts General Hospital in Boston, researchers led by Angelo Volandes, MD, examined how video could be used to help older people make health care decisions about possible future illness — dementia, in particular. In a randomized, controlled study at four primary care clinics, 200 healthy people 65 and older were divided into two groups. One group listened to an oral presentation on dementia, while the other listened to the same presentation and also viewed a two-minute video of a daughter’s visit with her 80-year-old mother who had advanced dementia and was being cared for in a nursing home. The daughter lovingly feeds the woman dinner while attempting conversation, but her mother is unable to respond.

Immediately after the presentations, researchers outlined care options for people with advanced dementia. Included were life-prolonging care, which uses all medical means to extend life… limited care to maintain physical functioning… or comfort care to provide only measures that alleviate pain and discomfort. They asked participants which they’d choose if they had the disease. They found that…

  • In the group that listened to the oral presentation, 64% opted for comfort care… 19% limited care… 14% life-prolonging care… and 3% were unsure.
  • In the video group, 86% chose comfort care… 9% limited care… 4% life-prolonging care… and 1% were unsure.
  • When asked again six weeks later, people who had viewed the video were less likely to change their minds. In the verbal group, 29% altered their preferences, compared with only 6% in the video group.

Results of the study were published in the May 28, 2009, online edition of BMJ. View the video at www.bmj.com/video/care_preferences_dementia.dtl.

Make Plans When You Are Still Well

The video is not meant to steer viewers in a particular direction and also does not replace discussion, Dr. Volandes emphasizes. It does provide information and reinforcement for vitally important conversations. He told me that he believes that video can be a valuable tool to help give people a realistic understanding of what it is like to live with advanced dementia. The vast majority of participants said that they would recommend the video to others — which suggests that they were comfortable with it, not frightened or intimidated.

Dr. Volandes told me that in his experience, seniors want to talk about end-of-life issues and welcome an opportunity to make informed decisions. He recommends raising these issues with your doctor and family to make your preferences clear. Do this when you can discuss matters calmly and dispassionately, when you are still healthy — or as soon as possible after a serious disease is diagnosed. Knowing the facts gives you the tools to make an informed decision — and when the decision relates to how to spend the final days of your life, the stakes couldn’t be higher.