For Illinois Healthcare Professionals

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

If the changes caused by dementia result in any of the following:

• I no longer appear to desire food or drink, turn my head, or otherwise avoid being fed or given fluids
• I do not open my mouth to accept food or drink without prompting, and all food or drink must be provided by a caregiver (hand or spoon-feeding)
• I am unable to safely swallow food or drink (cough, choke, or aspirate/inhale)
• The negative consequences of continued food or drink, as determined by a medical provider, outweigh the benefits

Learn more about nutrition support and artificial hydration

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.

Si los cambios causados por la demencia provocan algo de lo siguiente:

• Parece que ya no deseo comer ni beber (giro la cabeza, escupo la comida, no abro la boca). 
• Dependo de otra persona para que me proporcione toda la comida y bebida (también conocido como alimentación a mano o con cuchara). 
• No puedo tragar alimentos o con seguridad (toso, me atraganto o aspiro/inhalo) 
• Las consecuencias negativas de seguir comiendo o bebiendo, determinadas por un médico, son mayores que los beneficios.

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

If the changes caused by dementia result in any of the following:

• I no longer appear to desire food or drink, turn my head, or otherwise avoid being fed or given fluids
• I do not open my mouth to accept food or drink without prompting, and all food or drink must be provided by a caregiver (hand or spoon-feeding)
• I am unable to safely swallow food or drink (cough, choke, or aspirate/inhale)
• The negative consequences of continued food or drink, as determined by a medical provider, outweigh the benefits

Learn more about nutrition support and artificial hydration