- Email: [email protected]
O2.11: Improving advance care planning in patients with dementia in a nursing home: defining facilitating factors and barriers
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Oral presentations / European Geriatric Medicine 5S1 (2014) S45–S81
of delirium per 100 patients receiving the treatment) (Table 2); MODERATE when used to prevent delirium in medical setting (2 controlled clinical trials: 6 fewer cases of delirium); VERY-LOW when used to treat delirium. The quality of evidence of single component non-pharmacological interventions was deemed: VERY-LOW. Conclusions: The Ontop Group developed the most systematic and transparent recommendations about use of non pharmacological interventions for the treatment and prevention of delirium in older patients. Funding: European Union Seventh Framework Programme (FP7/2007–2013), grant agreement no. 305930 (SENATOR).
Ethics/End of life care
Survey (ADAS) and questionnaires including socio-demographic and health related characteristics through face to face interview. The Data were analyzed using t-test, one way ANOVA, and Scheff’s test. Result: The mean score of ADAS was 45.12, which showed subjects’ positive attitudes toward ADs. 61.1% of subjects agreed to have ADs. Among socio-demographic characteristics, age, level of education, and monthly income were significantly related to the subjects’ attitudes toward ADs. In addition, the medical service use, medical expense, experiences of significant others’ admission in intensive care unit and death were significantly related factors to the subjects’ attitudes toward ADs. Conclusion: The findings from this study suggests that thoughtful approaches with respecting the values and attitude of older adults need to be considered for adapting ADs to Korean health care systems.
O2.09 Quality of dying in nursing home residents dying with dementia: Does advanced care planning matter?
O2.11 Improving advance care planning in patients with dementia in a nursing home: defining facilitating factors and barriers
L. van den Block1 , A. Vandervoort1 , D. Houttekier1 , J.T. van der Steen2 1 Vrije Universiteit Brussel, Brussels, Belgium; 2 VU University Medical Center, Amsterdam, The Netherlands
M.W. Wils1 , J.L. Lisaerde2 , J.V. Verbakel2 1 UZ Leuven, Leuven, Belgium; 2 Academisch Centrum voor Huisartsgeneeskunde KULeuven, Leuven, Belgium
Background: Advance care planning (ACP) is considered a central component of high-quality palliative care and especially relevant for people with dementia. We investigated to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general practitioner orders, are related to the quality of dying of nursing home residents with dementia. Methods: Cross-sectional study of deaths (2010) using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a threemonth period were reported; for each, the nurse most involved in care, GP and closest relative completed structured questionnaires. Findings: Among 101 deaths of residents with dementia, a written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety) on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI, 1.1–11) than for those without either (AOR 2.99; CI, 1.1–8.3). We found no association between verbal communication or having a GP order and quality of dying. Conclusion: For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life underpinning the importance of ACP. O2.10 The attitudes toward advance directives of older adults using senior centers in South Korea Y.H. Park, H.L. Lee Seoul National University, Seoul, South Korea Purpose: The aims of this study were to identify the attitudes toward advance directives (ADs) of community dwelling older adults and factors related to ADs. Method: The participants were 180 older Korean (mean age = 74.2 yrs, 70.6% Female) adults using two senior centers in metropolitan city in South Korea. The Data were collected from September 7th to 30th in 2011, using Advanced Directives Attitude
Background: Advance care planning consists of an individual approach to anticipate on decisions of treatment during the course of illness and at the end of life. In a nursing home setting there is a pressing need for advance care planning, especially for residents with dementia. Objectives: The aim of the study is to assess the effect of an education programme for nurses on the registration of ACP-related issues in a specific nursing home with a population of elderly residents suffering from dementia. Another objective was to explore the views of nursing home staff on advance care planning in patients with dementia. Methods: This quantitative study is a pre- and post intervention evaluation in a nursing home in Flanders, Belgium, providing care for a population of 124 residents diagnosed with dementia. The intervention consisted of a 12-month program for nursing staff (n = 13) including training in theoretical and communication skills. This group was asked to complete a structured Likert type 10item-questionnaire at 0 and 12 months between January 2011 and January 2012 exploring their views on facilitating and obstructing factors concerning the implementation of ACP. At the same time a pre- and post measurement of all ACP-related registrations in the electronic medical record was done. Results: After the intervention we noted a significant increase in the number of ACP-related registrations in the electronic patient file. We identified several facilitating factors and barriers for the ACP process. Furthermore we saw prominent changes in caregiver’s views on ACP at the end of the intervention period.
Longevity O2.12 High morale is associated with increased survival in the very old 1 H. Niklasson1 , C. Hornsten ¨ , M. Conradsson1 , F. Nyqvist2 , 1 B. Olofsson1 , H. Lovheim ¨ , Y. Gustafson1 1 Ume˚ a University, Ume˚ a, Sweden; 2 National Institute for Health and Welfare, Vaasa, Finland
Background: High morale is defined as future-oriented optimism regarding the opportunities and problems associated with ageing. Previous research suggests that high level of morale independently predicts increased survival among old people, however very old
Oral presentations / European Geriatric Medicine 5S1 (2014) S45–S81
of delirium per 100 patients receiving the treatment) (Table 2); MODERATE when used to prevent delirium in medical setting (2 controlled clinical trials: 6 fewer cases of delirium); VERY-LOW when used to treat delirium. The quality of evidence of single component non-pharmacological interventions was deemed: VERY-LOW. Conclusions: The Ontop Group developed the most systematic and transparent recommendations about use of non pharmacological interventions for the treatment and prevention of delirium in older patients. Funding: European Union Seventh Framework Programme (FP7/2007–2013), grant agreement no. 305930 (SENATOR).
Ethics/End of life care
Survey (ADAS) and questionnaires including socio-demographic and health related characteristics through face to face interview. The Data were analyzed using t-test, one way ANOVA, and Scheff’s test. Result: The mean score of ADAS was 45.12, which showed subjects’ positive attitudes toward ADs. 61.1% of subjects agreed to have ADs. Among socio-demographic characteristics, age, level of education, and monthly income were significantly related to the subjects’ attitudes toward ADs. In addition, the medical service use, medical expense, experiences of significant others’ admission in intensive care unit and death were significantly related factors to the subjects’ attitudes toward ADs. Conclusion: The findings from this study suggests that thoughtful approaches with respecting the values and attitude of older adults need to be considered for adapting ADs to Korean health care systems.
O2.09 Quality of dying in nursing home residents dying with dementia: Does advanced care planning matter?
O2.11 Improving advance care planning in patients with dementia in a nursing home: defining facilitating factors and barriers
L. van den Block1 , A. Vandervoort1 , D. Houttekier1 , J.T. van der Steen2 1 Vrije Universiteit Brussel, Brussels, Belgium; 2 VU University Medical Center, Amsterdam, The Netherlands
M.W. Wils1 , J.L. Lisaerde2 , J.V. Verbakel2 1 UZ Leuven, Leuven, Belgium; 2 Academisch Centrum voor Huisartsgeneeskunde KULeuven, Leuven, Belgium
Background: Advance care planning (ACP) is considered a central component of high-quality palliative care and especially relevant for people with dementia. We investigated to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general practitioner orders, are related to the quality of dying of nursing home residents with dementia. Methods: Cross-sectional study of deaths (2010) using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a threemonth period were reported; for each, the nurse most involved in care, GP and closest relative completed structured questionnaires. Findings: Among 101 deaths of residents with dementia, a written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety) on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI, 1.1–11) than for those without either (AOR 2.99; CI, 1.1–8.3). We found no association between verbal communication or having a GP order and quality of dying. Conclusion: For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life underpinning the importance of ACP. O2.10 The attitudes toward advance directives of older adults using senior centers in South Korea Y.H. Park, H.L. Lee Seoul National University, Seoul, South Korea Purpose: The aims of this study were to identify the attitudes toward advance directives (ADs) of community dwelling older adults and factors related to ADs. Method: The participants were 180 older Korean (mean age = 74.2 yrs, 70.6% Female) adults using two senior centers in metropolitan city in South Korea. The Data were collected from September 7th to 30th in 2011, using Advanced Directives Attitude
Background: Advance care planning consists of an individual approach to anticipate on decisions of treatment during the course of illness and at the end of life. In a nursing home setting there is a pressing need for advance care planning, especially for residents with dementia. Objectives: The aim of the study is to assess the effect of an education programme for nurses on the registration of ACP-related issues in a specific nursing home with a population of elderly residents suffering from dementia. Another objective was to explore the views of nursing home staff on advance care planning in patients with dementia. Methods: This quantitative study is a pre- and post intervention evaluation in a nursing home in Flanders, Belgium, providing care for a population of 124 residents diagnosed with dementia. The intervention consisted of a 12-month program for nursing staff (n = 13) including training in theoretical and communication skills. This group was asked to complete a structured Likert type 10item-questionnaire at 0 and 12 months between January 2011 and January 2012 exploring their views on facilitating and obstructing factors concerning the implementation of ACP. At the same time a pre- and post measurement of all ACP-related registrations in the electronic medical record was done. Results: After the intervention we noted a significant increase in the number of ACP-related registrations in the electronic patient file. We identified several facilitating factors and barriers for the ACP process. Furthermore we saw prominent changes in caregiver’s views on ACP at the end of the intervention period.
Longevity O2.12 High morale is associated with increased survival in the very old 1 H. Niklasson1 , C. Hornsten ¨ , M. Conradsson1 , F. Nyqvist2 , 1 B. Olofsson1 , H. Lovheim ¨ , Y. Gustafson1 1 Ume˚ a University, Ume˚ a, Sweden; 2 National Institute for Health and Welfare, Vaasa, Finland
Background: High morale is defined as future-oriented optimism regarding the opportunities and problems associated with ageing. Previous research suggests that high level of morale independently predicts increased survival among old people, however very old