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Substitute Decision Making for Individuals with Dementia



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Substitute Decision Making for Individuals with Dementia Advance Care Planning and Advanced Directives Josephine Gittler Wiley B Rutledge Professor of Law Director National Health Law and Policy Resource Center College of Law University of Iowa Planning for the Best 2010 Iowa City Iowa October 22 2010 The Aging US Population In 2009 The number of persons 65 years of age or older was 39 6 million or 12 9 of the total population The number Th b off persons 85 years off age or older ld was 5 6 million or 1 8 of the total population Source US Census Bureau 2009 Population Estimates Sex by Age 2009 1 The Aging Iowa Population Iowa ranks 4th in percentage of population 65 years of age and older Iowa ranks 2nd in percentage of population 85 years of age and older Rural Iowa is home to many of IA s elders Source Center on Aging University of Iowa Dementias Nature and Extent Dementia is a group of symptoms affecting the intellectual and social abilities severely enough to interfere with daily functioning It is not part of normal aging Alzheimer s disease is the most common type of dementia Risk of dementia increases with advancing age Nearly one half of people over 85 years have dementia 13 2 Dementias Nature and Extent con t 1 off 8 individuals i di id l 65 years off age and d older ld have h Alzheimer s disease Alzheimer s disease is the 6th leading cause of death nationwide Alzheimer s disease is the 5th leading cause of death in Iowa Sources Alzheimer s Association Iowa Department of Health Vital Statistics 14 Common Law Underpinnings and Constitutional Framework The Karen Quinlan case The Nancy Cruzan case The Terri Schiavo case 3 History of Advance Directives Living Will Durable Power of Health Care Attorney Advance Directive Iowa Code Chapter 144A Life Sustaining Procedures Act Living will is called declaration Chapter 144B Durable Power of Attorney for Health Care Act 4 Iowa Code Living Will Declaration Scope Applicability A competent adult may execute a declaration



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