Advance Directives in Mild Dementia: Barriers and Facilitators in the Taiwanese Healthcare Context

Objectives To synthesize the multidimensional barriers and facilitators influencing advance directive (AD) engagement among people with mild dementia in Taiwan and identify practice and policy considerations that may support earlier and more effective advance care planning (ACP). Methods A narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify English- and Chinese-language literature published from January 2000 to June 2025. Studies addressing AD or ACP engagement among people with dementia, mild cognitive impairment, older adults, caregivers, or healthcare professionals were considered. Relevant findings were narratively synthesized and organized into individual, familial, social, and national domains. Results Fifty-one sources were included. AD engagement was influenced by interacting factors across all four domains. At the individual level, greater understanding of dementia progression, positive attitudes toward autonomy, and psychological readiness facilitated engagement, whereas fear, denial, and misconceptions about end-of-life care created barriers. Family communication, consensus, and previous experiences with AD could either facilitate or delay decision-making. Social barriers included cultural reluctance to discuss death and unequal access to ACP services. At the national level, multidisciplinary ACP models, structured communication approaches, public education, and Taiwan’s centralized AD registry supported implementation, whereas workforce limitations and delayed initiation remained important challenges. Conclusions Improving AD engagement among people with mild dementia requires timely, dementia-adapted and family-inclusive ACP that preserves individual autonomy. Integrating structured ACP into routine dementia care, strengthening multidisciplinary training, and expanding community-based access may help ensure that future care reflects patients’ values and preferences.