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Trigger events that indicate the need for proxy decision-making in cognitively impaired older persons

The University of Texas School of Nursing, Austin, Texas

Mary G. Weisensee, PhD, RN

University of Minnesota School of Nursing, Minneapolis, Minnesota

Joanne B. Anderson, MN, RN

College of Nursing, South Dakota State University, Brookings, South Dakota

The purpose of this exploratory study was to ascertain the primary event or "trigger" that prompted caregivers to initiate planning for a change in monitoring or substitute decision-making needed for the older person receiving their care. Understanding the impetus to make this decision can help caregivers to anticipate needs and plan accordingly. Caregivers from the community who did not choose guardianship (N=39) and caregivers who were court-appointed guardians or conservators (N=22) were compared for their views about the trigger events, the views of their own health, number of hours in caregiving and the circumstances surrounding the decision-making experience. Three categories of trigger events were identified:

• • Physical;
  
• • Emotional/cognitive; and
  
• • Situational events with the vast majority of triggers falling into the first two categories.
  

Guardians as a group were younger, provided fewer hours of caregiving and rated themselves healthier than the other caregivers. A variety of situational stressors were identified by respondents with time and financial concerns the primary concerns. Further research with a wider variety of caregiving dyads is recommended to examine the decision-making process involved and to further validate the categorization of trigger events.

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