A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia

Robinson, Louise, Dickinson, Claire, Rousseau, Nikki, Beyer, Fiona, Clark, Alexa, Hughes, Julian, Howel, Denise and Exley, Catherine (2012) A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia. Age and Ageing, 41 (2). pp. 263-269. ISSN 0002-0729

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Official URL: http://dx.doi.org/10.1093/ageing/afr148

Abstract

Background: advance care planning (ACP) allows a patient to state their preferences for care, so that if in future they cannot make decisions their wishes are known. Our aim was to review systematically the effectiveness of ACP interventions in people with cognitive impairment and dementia.
Methods: systematic searches of key electronic databases, supplemented by hand searches of reference lists and consultation with experts. Two independent reviewers undertook screening, data extraction and quality assessment.
Results: four studies were included; three allocated providers randomly to intervention or control arm. All took place in nursing homes. Three studies reported formal processes of capacity assessment, only up to 36% of participants were judged to have capacity. Three studies reported positive findings in terms of documentation of patient preferences for care. Two studies reported significant reductions in hospitalisation rates; a third found increased use of hospice services in the intervention group. A meta-analysis could not be carried out due to heterogeneity of outcome measures.
Conclusions: there is limited evidence for the effectiveness of ACP in people with cognitive impairment/dementia in terms of ACP documentation and health-care use. In terms of capacity to discuss ACP, nursing home settings may be too late for people with dementia.

Item Type: Article
Uncontrolled Keywords: systematic review, advance care planning, advance directives, dementia, nursing homes, elderly
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Ay Okpokam
Date Deposited: 14 Feb 2017 13:01
Last Modified: 24 Oct 2017 11:47
URI: http://nrl.northumbria.ac.uk/id/eprint/29666

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