Improving the end-of-life for people with dementia living in a care home: an intervention study.
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.


CONCLUSIONS
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.
Mental Health Sciences Unit, UCL, 67-73 Riding House Street 2nd Floor, Charles Bell House, London W1W 7EJ, UK.
Gill
G
Livingston
Elanor
E
Lewis-Holmes
Catherine
C
Pitfield
Monica
M
Manela
Diana
D
Chan
Eleanor
E
Constant
Hannah
H
Jacobs
Gaby
G
Wills
Natasha
N
Carson
Jackie
J
Morris
D032722:Advance Care Planning / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000628:therapy*; D005190:Family; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods* / Q000592:standards