AAC End-of-Life & Palliative Care 2 — Questions and Answers
Question 1: Which document legally appoints a person to make healthcare decisions for someone with Alzheimer's who loses decision-making capacity?
- Living will
- Durable power of attorney for healthcare (Correct answer)
- Do-not-resuscitate order
- POLST form
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) designates a specific individual to make medical decisions when the person can no longer do so.
Question 2: A family insists on tube feeding for their mother with late-stage Alzheimer's despite evidence it does not prolong life comfortably. The care team's best response is to:
- Immediately comply with the family's wishes
- Explain that hand-feeding supports comfort and dignity without prolonging suffering (Correct answer)
- Defer entirely to the physician's preference
- Refuse care until the family agrees
Correct answer: Explain that hand-feeding supports comfort and dignity without prolonging suffering
Evidence shows tube feeding in late-stage dementia does not improve survival or prevent aspiration and can cause discomfort, so hand-feeding is the recommended comfort-focused alternative.
Question 3: Pain assessment in a non-verbal Alzheimer's patient is BEST accomplished using:
- Patient self-report on a numeric scale
- Family assumption based on diagnosis
- Behavioral observation tools such as PAINAD (Correct answer)
- Routine scheduled analgesics without assessment
Correct answer: Behavioral observation tools such as PAINAD
The PAINAD (Pain Assessment in Advanced Dementia) scale uses observable behaviors like facial grimacing and vocalizations to estimate pain in non-verbal patients.
Question 4: Which ethical principle is most central when honoring a person with Alzheimer's previously expressed wish to avoid aggressive life-prolonging treatment?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Non-maleficence
Correct answer: Autonomy
Autonomy — respecting the individual's right to make their own decisions, including those made in advance — is the guiding principle when following prior directives.
Question 5: What is 'anticipatory grief' in the context of Alzheimer's caregiving?
- Grief that occurs only after the person dies
- Grief experienced before death in response to ongoing losses (Correct answer)
- A clinical diagnosis requiring medication
- Grief that is considered inappropriate or premature
Correct answer: Grief experienced before death in response to ongoing losses
Anticipatory grief occurs as caregivers mourn ongoing losses — of the person's personality, abilities, and the relationship — before the physical death occurs.
Question 6: Which symptom is MOST commonly undertreated in people with advanced Alzheimer's disease?
- Hypertension
- Pain (Correct answer)
- Hyperglycemia
- Insomnia
Correct answer: Pain
Pain is chronically undertreated in people with advanced dementia because they cannot reliably self-report it and behavioral pain cues are often misinterpreted.
Question 7: A POLST (Physician Orders for Life-Sustaining Treatment) form differs from an advance directive in that it:
- Is only valid in hospital settings
- Is a signed medical order that is immediately actionable by first responders (Correct answer)
- Requires an attorney to prepare
- Applies only to patients under age 65
Correct answer: Is a signed medical order that is immediately actionable by first responders
POLST is a portable, signed medical order that translates treatment preferences into actionable instructions valid across care settings and honored by EMS.
AAC End-of-Life & Palliative Care 2
Which document legally appoints a person to make healthcare decisions for someone with Alzheimer's who loses decision-making capacity?