Advanced Care Planning is Crucial for End-of-Life Care

The proportion of older adults is continuously rising throughout the world due to great advances in medical and technological innovations. Unfortunately, many older adults lose their functional independence and are unable to reside in the community, leading to large numbers needing long-term care in nursing homes and assisted living facilities. This population of elderly people is increasingly frail and suffers from many illnesses. Consequently, acute healthcare is frequently utilized with high hospital admissions.

The nursing home population receives 24-hour care from nurses or support staff. The ratio of residents to staff is significantly increasing, leading to more residents experiencing unnecessary hospital admissions. Strong evidence has shown that interventions such as advance care planning (ACP) significantly decrease hospital transfer from nursing homes. Studies have shown that most older adults welcome the chance to voice their preferences regarding end-of-life care, which ACP allows.

It is critical that elderly patients are given opportunities to express their desires regarding healthcare decisions, should their ability to be engaged in these conversations decrease in the future. Loss of capability may be temporary, such as during times of acute illness or delirium, or long-lasting and progressive due to dementia. Approximately 50% to 80% of nursing home residents have dementia, which debilitates their decision-making ability and makes ACP crucial for this type of vulnerable people. Substantial evidence supports the prioritization of ongoing ACP in nursing home care.

An article recently published in the Journal of the American Medical Directors Association discusses a study that explored the effects of ACP on the nursing home population. Researchers of the study conducted a comprehensive literature search using four popular databases: Embase, Medline, PyschINFO, and CINAHL, with no limitations on year or language.  Thirteen studies our of an initial search result of 4654 articles fit inclusion criteria for analysis.  The ACP interventions were composed of 5 studies analyzing educational programs, 5 studies evaluating various forms of ACP, 2 studies describing an ACP program incorporating palliative care, and 1 study analyzing the effect of do not resuscitate orders on medical treatments for infections pertaining to the respiratory system. Researchers of the analysis found that hospitalization rates decreased when ACP was used. Analysis also showed that there was a significant increase in the number of residents dying in their nursing home instead of the hospital due to ACP. Furthermore, ACP increased medical treatments that were harmonious with patients’ wishes. Two studies found an overall reduction in health expenses. One study found that community palliative care was more frequently used due to ACP.

In conclusion, ACP has significant benefits for the nursing home population. There are a variety of forms of ACP interventions, and being able to identify which type of intervention is superior and more effective over the other is a challenge.  Advance care planning should be utilized in the older adult population living in long-term care facilities such as nursing homes to promote quality of care even at the end of life.