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Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium : a prospective cohort study

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Abstract
Aim: To describe (i) the timing of initiation of advance care planning (ACP) after nursing home admission; (ii) the association of dementia and physical health with ACP initiation; and (iii) if and how analgesic use and use of lipid modifying agents is related to ACP, in a cohort of newly admitted residents. Methods: A prospective, observational cohort study of nursing home residents was carried out. Data were collected 3 months, 15 months (year 1) and 27 months (year 2) after admission, using a structured questionnaire and validated measuring tools. Results: ACP was never initiated during the 2-year stay for 38% of the residents, for 22% ACP was initiated at admission, for 21% during year 1 and for 19% during year 2 (n = 323). ACP initiation was strongly associated with dementia, but not with physical health. Residents without dementia were more likely to have ACP initiation at admission or not at all, whereas ACP initiation was postponed for residents with dementia. Between admission and year 2, analgesic use increased (from 34% to 42%), and the use of lipid-modifying agents decreased (from 28% to 21%). Analgesic use increased more in residents with ACP initiation during year 1 and year 2. The use of lipid-modifying agents was not associated with ACP. Conclusions: The timing of ACP initiation differed significantly for residents with and without dementia, which highlights the importance of an early onset of ACP before residents lose their decision-making capacity. ACP conversations might create opportunities to discuss adequate pain and other symptom treatment, and deprescribing at the end of life.
Keywords
advance care planning, analgesics, cohort study, dementia, nursing home, OF-LIFE CARE, DECISION-MAKING, NATIONWIDE, END, RECOMMENDATIONS, DIRECTIVES, DEMENTIA, ILLNESS, ORDERS

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Chicago
Paque, Kristel, Ivana Ivanova, Monique Elseviers, Robert Vander Stichele, Tinne Dilles, Koen Pardon, Luc Deliens, and Thierry Christiaens. 2019. “Initiation of Advance Care Planning in Newly Admitted Nursing Home Residents in Flanders, Belgium : a Prospective Cohort Study.” Geriatrics & Gerontology International 19 (2): 141–146.
APA
Paque, K., Ivanova, I., Elseviers, M., Vander Stichele, R., Dilles, T., Pardon, K., Deliens, L., et al. (2019). Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium : a prospective cohort study. GERIATRICS & GERONTOLOGY INTERNATIONAL, 19(2), 141–146.
Vancouver
1.
Paque K, Ivanova I, Elseviers M, Vander Stichele R, Dilles T, Pardon K, et al. Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium : a prospective cohort study. GERIATRICS & GERONTOLOGY INTERNATIONAL. 2019;19(2):141–6.
MLA
Paque, Kristel et al. “Initiation of Advance Care Planning in Newly Admitted Nursing Home Residents in Flanders, Belgium : a Prospective Cohort Study.” GERIATRICS & GERONTOLOGY INTERNATIONAL 19.2 (2019): 141–146. Print.
@article{8585208,
  abstract     = {Aim: To describe (i) the timing of initiation of advance care planning (ACP) after nursing home admission; (ii) the association of dementia and physical health with ACP initiation; and (iii) if and how analgesic use and use of lipid modifying agents is related to ACP, in a cohort of newly admitted residents.
Methods: A prospective, observational cohort study of nursing home residents was carried out. Data were collected 3 months, 15 months (year 1) and 27 months (year 2) after admission, using a structured questionnaire and validated measuring tools.
Results: ACP was never initiated during the 2-year stay for 38% of the residents, for 22% ACP was initiated at admission, for 21% during year 1 and for 19% during year 2 (n = 323). ACP initiation was strongly associated with dementia, but not with physical health. Residents without dementia were more likely to have ACP initiation at admission or not at all, whereas ACP initiation was postponed for residents with dementia. Between admission and year 2, analgesic use increased (from 34% to 42%), and the use of lipid-modifying agents decreased (from 28% to 21%). Analgesic use increased more in residents with ACP initiation during year 1 and year 2. The use of lipid-modifying agents was not associated with ACP.
Conclusions: The timing of ACP initiation differed significantly for residents with and without dementia, which highlights the importance of an early onset of ACP before residents lose their decision-making capacity. ACP conversations might create opportunities to discuss adequate pain and other symptom treatment, and deprescribing at the end of life.},
  author       = {Paque, Kristel and Ivanova, Ivana and Elseviers, Monique and Vander Stichele, Robert and Dilles, Tinne and Pardon, Koen and Deliens, Luc and Christiaens, Thierry},
  issn         = {1444-1586},
  journal      = {GERIATRICS & GERONTOLOGY INTERNATIONAL},
  keywords     = {advance care planning,analgesics,cohort study,dementia,nursing home,OF-LIFE CARE,DECISION-MAKING,NATIONWIDE,END,RECOMMENDATIONS,DIRECTIVES,DEMENTIA,ILLNESS,ORDERS},
  language     = {eng},
  number       = {2},
  pages        = {141--146},
  title        = {Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium : a prospective cohort study},
  url          = {http://dx.doi.org/10.1111/ggi.13576},
  volume       = {19},
  year         = {2019},
}

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