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Advance directives and physicians' orders in nursing home residents with dementia in Flanders, Belgium: prevalence and associated outcomes.
Int Psychogeriatr. 2012 Jul; 24(7):1133-43.IP

Abstract

BACKGROUND

Advance care planning (ACP) is an important element of high-quality care in nursing homes, especially for residents having dementia who are often incompetent in decision-making toward the end of life. The aim of this study was describe the prevalence of documented ACP among nursing home residents with dementia in Flanders, Belgium, and associated clinical characteristics and outcomes.

METHODS

All 594 nursing homes in Flanders were asked to participate in a retrospective cross-sectional postmortem survey in 2006. Participating homes identified all residents who had died over the last two months. A structured questionnaire was mailed to the nurses closely involved in the deceased resident's care regarding the diagnosis of dementia and documented care planning, i.e. advance patient directives, authorization of a legal representative, and general practitioners' treatment orders (GP orders).

RESULTS

In 345 nursing homes (58% response rate), nurses identified 764 deceased residents with dementia of whom 62% had some type of documented care plan, i.e. advance patient directives in 3%, a legal representative in 8%, and GP orders in 59%. Multivariate logistic regression showed that the presence of GP orders was positively associated with receiving specialist palliative care in the nursing home (OR 3.10; CI, 2.07-4.65). Chances of dying in a hospital were lower if there was a GP order (OR 0.38; CI, 0.21-0.70).

CONCLUSIONS

Whereas GP orders are relatively common among residents with dementia, advance patient directives and a legal representative are relatively uncommon. Nursing home residents receiving palliative care are more likely to have a GP order. GP orders may affect place of death.

Authors+Show Affiliations

End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium. An.Vandervoort@vub.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22364648

Citation

Vandervoort, An, et al. "Advance Directives and Physicians' Orders in Nursing Home Residents With Dementia in Flanders, Belgium: Prevalence and Associated Outcomes." International Psychogeriatrics, vol. 24, no. 7, 2012, pp. 1133-43.
Vandervoort A, van den Block L, van der Steen JT, et al. Advance directives and physicians' orders in nursing home residents with dementia in Flanders, Belgium: prevalence and associated outcomes. Int Psychogeriatr. 2012;24(7):1133-43.
Vandervoort, A., van den Block, L., van der Steen, J. T., Vander Stichele, R., Bilsen, J., & Deliens, L. (2012). Advance directives and physicians' orders in nursing home residents with dementia in Flanders, Belgium: prevalence and associated outcomes. International Psychogeriatrics, 24(7), 1133-43. https://doi.org/10.1017/S1041610212000142
Vandervoort A, et al. Advance Directives and Physicians' Orders in Nursing Home Residents With Dementia in Flanders, Belgium: Prevalence and Associated Outcomes. Int Psychogeriatr. 2012;24(7):1133-43. PubMed PMID: 22364648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance directives and physicians' orders in nursing home residents with dementia in Flanders, Belgium: prevalence and associated outcomes. AU - Vandervoort,An, AU - van den Block,Lieve, AU - van der Steen,Jenny T, AU - Vander Stichele,Robert, AU - Bilsen,Johan, AU - Deliens,Luc, Y1 - 2012/02/27/ PY - 2012/2/28/entrez PY - 2012/3/1/pubmed PY - 2012/9/19/medline SP - 1133 EP - 43 JF - International psychogeriatrics JO - Int Psychogeriatr VL - 24 IS - 7 N2 - BACKGROUND: Advance care planning (ACP) is an important element of high-quality care in nursing homes, especially for residents having dementia who are often incompetent in decision-making toward the end of life. The aim of this study was describe the prevalence of documented ACP among nursing home residents with dementia in Flanders, Belgium, and associated clinical characteristics and outcomes. METHODS: All 594 nursing homes in Flanders were asked to participate in a retrospective cross-sectional postmortem survey in 2006. Participating homes identified all residents who had died over the last two months. A structured questionnaire was mailed to the nurses closely involved in the deceased resident's care regarding the diagnosis of dementia and documented care planning, i.e. advance patient directives, authorization of a legal representative, and general practitioners' treatment orders (GP orders). RESULTS: In 345 nursing homes (58% response rate), nurses identified 764 deceased residents with dementia of whom 62% had some type of documented care plan, i.e. advance patient directives in 3%, a legal representative in 8%, and GP orders in 59%. Multivariate logistic regression showed that the presence of GP orders was positively associated with receiving specialist palliative care in the nursing home (OR 3.10; CI, 2.07-4.65). Chances of dying in a hospital were lower if there was a GP order (OR 0.38; CI, 0.21-0.70). CONCLUSIONS: Whereas GP orders are relatively common among residents with dementia, advance patient directives and a legal representative are relatively uncommon. Nursing home residents receiving palliative care are more likely to have a GP order. GP orders may affect place of death. SN - 1741-203X UR - https://www.unboundmedicine.com/medline/citation/22364648/Advance_directives_and_physicians'_orders_in_nursing_home_residents_with_dementia_in_Flanders_Belgium:_prevalence_and_associated_outcomes_ L2 - https://www.cambridge.org/core/product/identifier/S1041610212000142/type/journal_article DB - PRIME DP - Unbound Medicine ER -