title: Advance directives and physicians' orders in nursing home residents with dementia in Flanders, Belgium: prevalence and associated outcomes.
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.affiliation: End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium. An.Vandervoort@vub.ac.be
authors.forename: An
authors.initials: A
authors.lastname: Vandervoort
authors.forename: Lieve
authors.initials: L
authors.lastname: van den Block
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards / Q000706:statistics & numerical data