{"id":5964,"date":"2023-12-15T20:20:35","date_gmt":"2023-12-15T20:20:35","guid":{"rendered":"https:\/\/finalexodus.org\/EndOfLife\/?page_id=5964"},"modified":"2026-10-10T22:38:10","modified_gmt":"2026-10-10T22:38:10","slug":"deep-dive","status":"publish","type":"page","link":"https:\/\/finalexodus.org\/EndOfLife\/deep-dive\/","title":{"rendered":"Deep Dive"},"content":{"rendered":"\t\t
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DEEP DIVE: ADVANCE DIRECTIVES AND DEMENTIA<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Some questions in end-of-life planning deserve a closer look. This section explores subjects that involve additional medical, legal, or practical considerations beyond the introductory information provided elsewhere on Final Exodus.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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VSED AND ADVANCE DIRECTIVES AFTER LOSS OF CAPACITY<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Voluntarily Stopping Eating and Drinking (VSED)<\/strong> ordinarily refers to a decision made by a person with decision-making capacity to voluntarily stop eating and drinking.<\/p>

A more complicated question arises when someone wants an advance directive to provide instructions concerning food and fluids after losing decision-making capacity, such as in advanced dementia. This is sometimes referred to as VSED by advance directive (VSED by AD).<\/strong><\/p>

The distinction matters because decisions about oral eating and drinking<\/strong> are not necessarily treated the same as decisions about medically administered nutrition and hydration<\/strong>, such as feeding tubes or intravenous fluids. The legal authority of a health care agent, the effect of instructions in an advance directive, and the obligations of caregivers and health care professionals can depend on state law, the language of the directive, the person’s circumstances, and whether the person continues to accept or request food or fluids.<\/p>

Advance directive laws generally allow people to document health care wishes and authorize another person to make certain health care decisions if they later lose capacity. Difficult questions can arise, however, when earlier written instructions appear to conflict with the behavior or expressed wishes of a person who no longer has decision-making capacity.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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CONSIDER THE ROLE OF YOUR HEALTH CARE AGENT<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Instructions concerning eating and drinking after future loss of decision-making capacity can place significant responsibility on a health care agent and others involved in the person’s care. An agent may be asked to interpret wishes expressed years earlier and respond to circumstances that could not have been fully anticipated when the advance directive was written.<\/p>

For that reason, having a conversation is essential.<\/strong> If your advance directive includes instructions concerning eating and drinking after loss of capacity, discuss them carefully with the person you have chosen as your health care agent. Make sure your agent understands your wishes, the values behind them, and the responsibility you may be asking that person to assume. Most importantly, make sure your agent is willing to serve in that role.<\/p>

Final Exodus provides both a\u00a0General Advance Health Care Directive <\/a><\/strong>and an Early Dementia Directive<\/a>.<\/strong><\/p>

. The Early Dementia Directive and its accompanying instructions provide additional guidance for people who want to document their wishes for future care in the event of cognitive decline.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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STATE LAWS MAY DIFFER<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Laws governing Advance Directives, health care agents, nutrition and hydration, and decisions made after loss of capacity vary by state. The effect of particular instructions may depend on the language of the Advance Directive, the person\u2019s circumstances, and applicable state law.<\/p>

These issues can become particularly important in planning for dementia, because a person\u2019s previously stated wishes may need to be interpreted years later, when that person may experience the world differently and no longer have the capacity to make the same complex decisions.<\/p>

For anyone considering instructions concerning eating and drinking after future loss of capacity, careful advance planning is especially important<\/strong>. Discuss your wishes with your health care agent and health care professionals, and consider obtaining legal guidance about the laws that apply where you live.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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BRAIN HEALTH AND REDUCING DEMENTIA RISK<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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There is currently no proven way to prevent Alzheimer\u2019s disease or other forms of dementia. Research suggests, however, that certain health and lifestyle factors may be associated with a lower risk of cognitive decline and dementia.<\/p>

Some risk factors, including age and genetics, cannot be changed. Others may be modifiable. Current research suggests that factors associated with brain and overall health may include:<\/p>