“Yes, I Consent!” Prevalence and Role of Guardianship in Older Inpatients: Findings From an Italian Multicenter Survey

Objective Guardianship is increasingly important as society ages, especially for people living with dementia (PWDs). This multicenter study assessed guardianship prevalence, practices, and caregiver engagement among hospitalized older adults, comparing those with and without dementia. Design Multicenter cross-sectional survey. Setting and participants Patients aged ≥65 years and their caregivers. Methods The survey was conducted in 11 tertiary Italian hospitals. Data on sociodemographics, clinical status, guardianship, and caregiver knowledge were collected. Results Among 409 patients (mean age 83.8 years; 63.1% needing daily assistance), only 8.8% had a legal guardian. Familiarity with guardianship laws was higher among caregivers of PWDs (61% vs 45.7%). Misconceptions were common: 70.3% of PWD caregivers reported making medical decisions without formal authority. Only 40% of PWD caregivers and 32.8% of others correctly recognized the need for legal guardianship. Conclusions and Implications A significant gap between the need for and use of legal guardianship emerged. Enhancing caregiver education is crucial to protect older adults' rights and autonomy.