Advance care planning, dementia and nursing homes.

Student thesis: Doctoral Thesis


Worldwide, every three seconds there is a new case of someone with dementia. As it is likely for people living with dementia to lose their decision-making capacity and their ability to communicate as the dementia progresses, advance care planning (ACP) is considered to be important. ACP is defined as ‘a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care’. Especially in nursing homes, where it is estimated that more than 65% of the people with dementia die, the uptake of ACP is low.

The aim of this PhD thesis was twofold: 1) To describe current evidence concerning ACP for people living with dementia and to examine to what extent ACP and end-of-life decision-making have changed over time among people with dementia; and 2) To evaluate the ACP+ intervention, an intervention program to improve the implementation of advance care planning in nursing homes in Flanders.

We found that ACP is important and acceptable for people with dementia and practiced more over the years. However, training and education for all parties involved is needed to further increase the uptake of ACP. We found ACP+ to lead to a significant improvement in self-efficacy in ACP of care staff, but no improvements in their ACP knowledge. These results underline the difficulties of changing ACP practices in the complex setting of nursing homes, but also hallmark first important steps towards improved care for this vulnerable population.
Date of Award29 Mar 2021
Original languageEnglish
Awarding Institution
  • Vrije Universiteit Brussel
SupervisorLieve Van den Block (Promotor), Lara Pivodic (Co-promotor), Raymond Koopmans (Jury), Birgitte Schoenmakers (Jury), Patricia De Vriendt (Jury), Koen Pardon (Jury), Liesbeth De Donder (Jury) & Tinne Smets (Jury)


  • advance care planning

Cite this