Advance directives and physician’s orders in nursing home residents dying with dementia in Flanders, Belgium: prevalence and associated outcomes. IPA Congres. Reinventing Aging Through Innovation.

ABSTRACT

Objectives: To describe prevalence of documented advance care planning among nursing home residents with dementia in Flanders, Belgium and associated clinical characteristics and outcomes.

Design: Retrospective cross-sectional postmortem survey (2006).

Setting: Nursing homes in Flanders, Belgium.

Participants: Residents deceased in the last two months.

Measurements: Structured questionnaire regarding diagnosis of dementia and documented care planning ie advance patient directives, authorization of a legal representative and general practitioners' treatment orders (GP orders), mailed to the nurse closely involved in the resident's care.

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 ie advance patient directives in 3%, a legal representative in 8% and GP orders in 59%. Multivariate logistic regression showed that presence of GP orders was positively associated with receiving specialist palliative care in the nursing home (OR 3.10; CI, 2.07 to 4.65). Chances of dying in a hospital were lower if there was a GP order (OR 0.38; CI, 0.21 to 0.70).

Conclusions: Whereas GP orders are relatively common among residents with dementia, advance patient directives and a legal representative are relatively uncommon. GP orders may affect place of death.