Dementia Values and Priorities Tool

The Dementia Values and Priorities Tool is designed to help you communicate your wishes regarding future care if you are living with dementia. After answering a series of questions related to the changes commonly seen in the progression of dementia, the tool will provide you with a document that can be added to your existing advance directive and shared with others. The interactive online tool is available in English and Spanish, and a printable version are available in multiple languages.

Tip: Look out for key terms in blue text as you go through the tool. Clicking on those terms opens a brief video that explains the concept in more detail.

If you prefer a printable version of the tool or are using a screen reader, click the button below for a downloadable copy.

Dementia Values and Priorities Tool®

Welcome

Throughout the tool, you will see key terms in blue underlined text. Clicking on those links will open a brief video to provide more information about that term.

Click on the blue arrow to the right to begin and move through the tool.

Getting Started

Every end-of-life plan should start with thinking about your values and wishes. For example, what will be most important to you in the final weeks or days of life? What does “quality of life” mean to you? How do you feel about the use of life-sustaining treatments (such as artificial nutrition, breathing assistance, medications) if diagnosed with a terminal illness?

Reminder: click on “quality of life” and other key terms in blue above for more information.

Advance Directive

An important part of every end-of-life plan is an Advance Directive (also known as a Living Will), which details your wishes for the medical treatment you do and do not want if a time comes that you are unable to speak for yourself. 

It also includes information about the person(s) you choose to make decisions if/when you become unable. This individual will be known as your Durable Power of Attorney for Healthcare, Healthcare Proxy or Surrogate.

Your Surrogate Decision Maker

The individual you choose as your Durable Power of Attorney for Healthcare or surrogate decision maker will work closely with your medical team to make decisions and communicate on your behalf when you become unable. Think carefully about who you choose for this role. 

A good surrogate is someone who: 

  • Is willing to take the time to really understand what is important to you  
  • You trust will carry out your wishes, even if they differ from their own 
  • Knows how to advocate and will speak up in a crisis 
  • Will be in the right emotional place to make difficult choices under pressure 
  • Will be able to navigate the family dynamics that may occur in a stressful situation

Additional Things to Consider

A few important reminders about your Advance Directive: 

  • Thoughtfully choose your surrogate decision maker, make sure they know your wishes and will be able to speak on your behalf 
  • Discuss your wishes and provide a copy of your advance directive to your surrogate decision maker, loved ones and medical team
  • Review your Advance Directive annually and update when any one of the “5 Ds” has occurred: Death of a loved one, Divorce, a new Diagnosis, Decline in health or you reach a new Decade.
  • Keep your Advance Directive in a place where it will be easily found by your surrogate decision maker and/or loved ones
  • Make sure your Advance Directive will be honored in all states you receive care or frequently visit 
  • You may also want to talk with your physician about completing a POLST form. To learn more and find information on a program in your state, visit the National POLST Coalition

A Dementia Advance Directive

The Dementia Values & Priorities Tool is a specific type of directive that focuses on symptoms and changes commonly seen in all types of dementia, including Alzheimer’s disease, Lewy Body Dementia, Frontotemporal Dementia (FTD), and Vascular Dementia.

Once completed, the signed document should be saved with your advance directive and shared with your healthcare team and surrogate decision maker(s).

Dementia Values & Priorities Tool

The Dementia Values & Priorities Tool focuses on the symptoms and changes commonly seen with advanced dementia. Take your time to think carefully about each and choose the type/level of care and support you would want in that situation.

All of your answers and information is confidential and will not be shared or used in any way. Responses are not saved when you exit the tool.

For the questions in the pop-up window, select one of three options to indicate your desired care preferences. 

Live as Long as Possible – My goal is to live as long as possible and receive aggressive medical care and life-saving treatments. This could include calling 911, going to the hospital, CPR, nutrition support, artificial hydration, or intubation if needed. 

Treat me but not AggressivelyI want to continue medications for chronic conditions (such as diabetes, heart disease) and treatments for illness (such as pneumonia, bladder infection). However, I want to avoid complex surgeries, life sustaining treatments, long-term feeding tubes and other aggressive, life-prolonging measures. 

Allow a Natural Death Medications and care should be for my comfort only. I do not want any medications or treatments that extend my life. This may include refusing surgery or treatment for infections, turning off pacemakers, stopping dialysis or blood transfusions and withdrawing treatment for heart disease, diabetes and other chronic conditions. 

Welcome

The Dementia Values & Priorities Tool is designed to help communicate your wishes regarding future care if you are living with dementia. After answering a series of questions related to the changes commonly seen in the progression of dementia, the tool will provide you with a document that can be added to your existing advance directive and shared with others. The interactive online tool is available in English and Spanish, and a printable version is available in multiple languages.

The Dementia Values and Priorities Tool is designed to help you communicate your wishes regarding future care if you are living with dementia.

Tip: Look out for key terms in blue text as you go through the tool. Clicking on those terms opens a brief video that explains the concept in more detail.

Getting Started

Every end-of-life plan should start with thinking about your values and wishes. For example, what will be most important to you in the final weeks or days of life? What does “quality of life” mean to you? How do you feel about the use of life-sustaining treatments (such as artificial nutrition, breathing assistance, medications) if diagnosed with a terminal illness?

Reminder: click on “quality of life” and other key terms in blue above for more information.

Advance Directive

An important part of every end-of-life plan is an Advance Directive (also known as a Living Will), which details your wishes for the medical treatment you do and do not want if a time comes that you are unable to speak for yourself. 

It also includes information about the person(s) you choose to make decisions if/when you become unable. This individual will be known as your Durable Power of Attorney for Healthcare, Healthcare Proxy or Surrogate.

Your Surrogate Decision Maker

The individual you choose as your Durable Power of Attorney for Healthcare or surrogate decision maker will work closely with your medical team to make decisions and communicate on your behalf when you become unable. Think carefully about who you choose for this role. 

A good surrogate is someone who: 

  • Is willing to take the time to really understand what is important to you  
  • You trust will carry out your wishes, even if they differ from their own 
  • Knows how to advocate and will speak up in a crisis 
  • Will be in the right emotional place to make difficult choices under pressure 
  • Will be able to navigate the family dynamics that may occur in a stressful situation

Additional Things to Consider

A few important reminders about your Advance Directive: 

  • Thoughtfully choose your surrogate decision maker, make sure they know your wishes and will be able to speak on your behalf 
  • Discuss your wishes and provide a copy of your advance directive to your surrogate decision maker, loved ones and medical team
  • Review your Advance Directive annually and update when any one of the “5 Ds” has occurred: Death of a loved one, Divorce, a new Diagnosis, Decline in health or you reach a new Decade.
  • Keep your Advance Directive in a place where it will be easily found by your surrogate decision maker and/or loved ones
  • Make sure your Advance Directive will be honored in all states you receive care or frequently visit 
  • You may also want to talk with your physician about completing a POLST form. To learn more and find information on a program in your state, visit the National POLST Coalition

A Dementia Advance Directive

The Dementia Values & Priorities Tool is a specific type of directive that focuses on symptoms and changes commonly seen in all types of dementia, including Alzheimer’s disease, Lewy Body Dementia, Frontotemporal Dementia (FTD), and Vascular Dementia.

Once completed, the signed document should be saved with your advance directive and shared with your healthcare team and surrogate decision maker(s).

Dementia Values & Priorities Tool

The Dementia Values & Priorities Tool focuses on the symptoms and changes commonly seen with advanced dementia. Take your time to think carefully about each and choose the type/level of care and support you would want in that situation.

All of your answers and information is confidential and will not be shared or used in any way. Responses are not saved when you exit the tool.

Instructions

For the questions in the pop-up window, select one of three options to indicate your desired care preferences. 

Live as Long as Possible – My goal is to live as long as possible and receive aggressive medical care and life-saving treatments. This could include calling 911, going to the hospital, CPR, nutrition support, artificial hydration, or intubation if needed. 

Treat me but not AggressivelyI want to continue medications for chronic conditions (such as diabetes, heart disease) and treatments for illness (such as pneumonia, bladder infection). However, I want to avoid complex surgeries, life sustaining treatments, long-term feeding tubes and other aggressive, life-prolonging measures. 

Allow a Natural Death Medications and care should be for my comfort only. I do not want any medications or treatments that extend my life. This may include refusing surgery or treatment for infections, turning off pacemakers, stopping dialysis or blood transfusions and withdrawing treatment for heart disease, diabetes and other chronic conditions. 

Are You a Clinician?

Essential Conversations is an initiative of to normalize end-of-life conversations and expand dementia-specific advance care planning nationwide.

General Mailing Address:
Compassion & Choices
8156 S Wadsworth Blvd #E-162
Littleton, CO 80128

Mail contributions directly to:
Compassion & Choices Gift Processing Center
PO Box 485
Etna, NH 03750

Compassion & Choices is a 501 C3 organization. Federal tax number: 84-1328829

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Paso 1 de 14

Yo estoy completando este documento porque quiero que mi(s) persona designada (s) en la toma de decisiones, médicos y equipo de atención médica, familia, cuidadores y seres queridos conozcan mis deseos respecto al tipo de cuidados que deseo si vivo con demencia.

Nombre
Fecha de nacimiento
Question 1 of 14

Your information entered here will be included on the final copy of your Dementia Advance Directive (addendum).

Name
Birth Date