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Improving the end-of-life for people with dementia living in a care home: an intervention study.
MedLine Citation:
PMID:  23924580     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT Background: One in three adults, most of whom are living in a care home at the time, dies with dementia. Their end-of-life is often in hospital, where they may experience uncomfortable interventions without known benefit and die rapidly with uncontrolled pain and comfort needs. This study aimed to improve end-of-life care for people with dementia in a care home by increasing the number and implementation of advanced care wishes. Methods: We recruited staff, residents with dementia, and their relatives from a 120-bed nursing home in London, UK. The intervention was a ten-session manualized, interactive staff training program. We compared advance care wishes documentation and implementation, place of death for residents who died, and themes from staff and family carers' after-death interviews pre- and post-intervention. Results: Post-intervention there were significant increases in documented advance care wishes arising from residents' and relatives' discussions with staff about end-of-life. These included do not resuscitate orders (16/22, 73% vs. 4/28, 14%; p < 0.001); and dying in the care homes as opposed to hospital (22/29, 76% vs. 14/30, 47%; p < 0.02). Bereaved relatives overall satisfaction increased from 7.5 (SD = 1.3) pre-intervention to 9.1 (SD = 2.4) post-intervention; t = 17.6, p = 0.06. Relatives reported increased consultation and satisfaction about decisions. Staff members were more confident about end-of-life planning and implementing advanced wishes. Conclusion: This small non-randomized study is the first end-of-life care in dementia intervention to report an increase in family satisfaction with a reduction in hospital deaths. This is promising but requires further evaluation in diverse care homes.
Authors:
Gill Livingston; Elanor Lewis-Holmes; Catherine Pitfield; Monica Manela; Diana Chan; Eleanor Constant; Hannah Jacobs; Gaby Wills; Natasha Carson; Jackie Morris
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-7
Journal Detail:
Title:  International psychogeriatrics / IPA     Volume:  -     ISSN:  1741-203X     ISO Abbreviation:  Int Psychogeriatr     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9007918     Medline TA:  Int Psychogeriatr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-10     Citation Subset:  -    
Affiliation:
Mental Health Sciences Unit, UCL, 67-73 Riding House Street 2nd Floor, Charles Bell House, London W1W 7EJ, UK.
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