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Observational Study
. 2025 Dec;58(8):681-687.
doi: 10.1007/s00391-025-02455-z. Epub 2025 Jun 27.

Advance directives in German memory clinics

Daniel Garmann  1   2 , Christina Abele  1   3 , Stefanie Baisch  1 , Jonas Karneboge  1 , Gregor Lindl  1   4 , Janina Florack  1   2 , Anna Theile-Schürholz  1 , Julia Haberstroh  5
Affiliations
Observational Study

Advance directives in German memory clinics

Daniel Garmann et al. Z Gerontol Geriatr. 2025 Dec.

Abstract
in English, German

People have the right to accept or refuse medical treatment provided they give voluntary, prior and informed consent. When capacity to consent is impaired, autonomy can be preserved through a clear, legally valid advance directive. Cognitive impairments, such as dementia, increase the risk of compromised capacity to consent. This study examines the prevalence of advance directives among patients at German memory clinics and explores predictors influencing their presence, focusing on compliance with informed consent standards.Using an observational cross-sectional design, 289 outpatients were assessed. Data included the presence of advance directives, circumstances of their creation and the patient characteristics age, gender, education, cognitive status, physical and mental health, need for autonomy in medical decision-making and health literacy. Descriptive statistics were calculated, and multivariable logistic regression models were applied to analyze the data.The results indicate that age is the strongest predictor for the presence of advance directives. Beyond age, specific events or experiences, rather than personal traits, may prompt individuals to create advance directives.

Jede Person hat das Recht, medizinische Behandlungen anzunehmen oder abzulehnen, sofern sie freiwillig, informiert und im Voraus einwilligt. Bei eingeschränkter Einwilligungsfähigkeit kann Autonomie durch eine eindeutige und rechtlich gültige Patientenverfügung gewahrt werden. Kognitive Beeinträchtigungen, wie sie etwa bei Demenz auftreten, erhöhen das Risiko einer eingeschränkten Einwilligungsfähigkeit. Diese Studie untersucht die Prävalenz von Patientenverfügungen bei Patienten in deutschen Gedächtnisambulanzen sowie Prädiktoren für deren Vorhandensein unter Berücksichtigung des Informed-Consent-Standards.In einer Querschnittsstudie mit 289 Patienten wurden das Vorhandensein von Patientenverfügungen, die Umstände ihrer Erstellung und patientenbezogene Merkmale wie Alter, Geschlecht, Bildung, kognitiver Status, körperliche und psychische Gesundheit, Autonomiebedürfnis und Gesundheitskompetenz erhoben. Deskriptive Statistiken und multivariable logistische Regressionsmodelle kamen zur Analyse zum Einsatz.Die Ergebnisse zeigen, dass Alter der stärkste Prädiktor für das Vorliegen von Patientenverfügungen ist, und konkrete Ereignisse oder Erfahrungen möglicherweise eine entscheidendere Rolle bei der Erstellung einer Patientenverfügung spielen als stabile individuelle Merkmale.

Keywords: Advance care planning; Dementia; End-of-life decisions; Informed consent; Patient autonomy.

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Conflict of interest statement

Declarations. Conflict of interest: D. Garmann, C. Abele, S. Baisch, J. Karneboge, G. Lindl, J. Florack, A. Theile-Schürholz and J. Haberstroh declare that they have no competing interests. Ethical standards: All procedures followed were in accordance with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study. The study procedure and materials have been reviewed and approved by the Ethics Committee of the Medical Council Westfalen-Lippe (trial no. 2021-518-f-S) and the Ethics Committee of the Medical Faculty at the Goethe University Frankfurt (trial no. 2021-559).

Figures

Fig. 1
Fig. 1
Deficits in meeting the informed consent standard
Fig. 2
Fig. 2
Frequency of advance directives (AD) with consideration of compliance with the informed consent standard * German school-leaving qualifications: Volks-/Hauptschule – basic/vocational level, Mittlere Reife – intermediate level, Abitur – top/academic level ** We classified MMSE scores of 27-30 points as “No cognitive impairment”, of 25-26 points as “MCI (Mild Cognitive Impairment)”, of 21-24 points as “Mild dementia”, and scores below 21 points as “Severe/moderate dementia”
See this image and copyright information in PMC

References

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