Original ArticlesDecision Making on Behalf of Elders With Advanced Cognitive Impairment: Family TransitionsElliott, Barbara A. PhD*; Gessert, Charles E. MD, MPH†; Peden-McAlpine, Cynthia PhD, RN‡Author Information *Medical School Duluth ‡School of Nursing, University of Minnesota †SMDC Health System, Duluth, MN Supported by grants from the National Institute on Aging (R03 AG21214-01) and the Duluth Clinic Education and Research Foundation. Reprints: Barbara A. Elliott, PhD, Medical School Duluth, University of Minnesota, Room 155-Medical School, 1035 University Drive, Duluth, MN 55812 (e-mail: firstname.lastname@example.org). Received for publication May 24, 2006; accepted November 2, 2006 Alzheimer Disease & Associated Disorders: January-March 2007 - Volume 21 - Issue 1 - p 49-54 doi: 10.1097/WAD.0b013e318030840a Buy Metrics Abstract Changes in family decision making responsibilities occur with progression of cognitive impairment. Focus groups with family members of nursing home residents with advanced cognitive impairment investigated values and beliefs used in making decisions for the elder. Family members described difficult decisions they had made to date, noting a significant transition in their decision making role when the elders' decisions needed to be superseded (especially with changes in living arrangements). In most families, one person or couple assumed the principal decision making responsibility. When decisions were made in the context of family conflict, managing the conflict became the focus, rather than the elder's care. In such cases, the elder's previously stated wishes regarding end of life care were not as likely to be honored. © 2007 Lippincott Williams & Wilkins, Inc.