Advance directives in European long-term care facilities: a cross-sectional survey.
advance directives
hospice and palliative care nursing
living wills
long-term care
palliative care
Journal
BMJ supportive & palliative care
ISSN: 2045-4368
Titre abrégé: BMJ Support Palliat Care
Pays: England
ID NLM: 101565123
Informations de publication
Date de publication:
21 May 2019
21 May 2019
Historique:
received:
14
12
2018
revised:
05
04
2019
accepted:
23
04
2019
entrez:
23
5
2019
pubmed:
23
5
2019
medline:
23
5
2019
Statut:
aheadofprint
Résumé
End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member.LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country.Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, 'Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%.LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.
Sections du résumé
BACKGROUND
BACKGROUND
End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries.
METHODS
METHODS
Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member.LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country.Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors.
RESULTS
RESULTS
In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, 'Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%.LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available.
CONCLUSION
CONCLUSIONS
Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.
Identifiants
pubmed: 31113800
pii: bmjspcare-2018-001743
doi: 10.1136/bmjspcare-2018-001743
pmc: PMC9380512
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
PLoS One. 2016 Apr 05;11(4):e0150686
pubmed: 27045734
Lancet. 2003 Aug 2;362(9381):345-50
pubmed: 12907005
Ann Intern Med. 2010 Aug 17;153(4):256-61
pubmed: 20713793
BMC Palliat Care. 2015 Dec 07;14:71
pubmed: 26643482
Lancet Oncol. 2017 Sep;18(9):e543-e551
pubmed: 28884703
Palliat Med. 2014 Sep;28(8):1000-25
pubmed: 24651708
Palliat Med. 2003 Jul;17(5):403-9
pubmed: 12882258
Palliat Med. 2016 Oct;30(9):807-24
pubmed: 26951066
Soc Sci Med. 2006 Mar;62(6):1552-63
pubmed: 16162380
J Pain Symptom Manage. 2011 Oct;42(4):565-77
pubmed: 21530152
Am J Hosp Palliat Care. 2008 Dec-2009 Jan;25(6):476-82
pubmed: 18843133
J Am Geriatr Soc. 2014 Apr;62(4):706-10
pubmed: 24697553
J Pain Symptom Manage. 2017 May;53(5):821-832.e1
pubmed: 28062339
Lancet. 2000 Nov 11;356(9242):1672-6
pubmed: 11089839
Arch Intern Med. 2006 Apr 24;166(8):890-5
pubmed: 16636215
Gerontology. 2004 Jul-Aug;50(4):247-54
pubmed: 15258431
Palliat Med. 2016 May;30(5):456-70
pubmed: 26396227
BMJ. 2010 Mar 23;340:c1345
pubmed: 20332506
BMC Geriatr. 2015 Oct 15;15:125
pubmed: 26470713
NCHS Data Brief. 2011 Jan;(54):1-8
pubmed: 21211169
J Am Med Dir Assoc. 2016 Jun 1;17(6):566.e1-7
pubmed: 27161314
Nurs Ethics. 2006 Jan;13(1):41-51
pubmed: 16425903
J Am Geriatr Soc. 2014 Jul;62(7):1304-9
pubmed: 24934237
Resuscitation. 2004 Jun;61(3):333-9
pubmed: 15172713
Nurs Ethics. 2004 Mar;11(2):165-78
pubmed: 15030024