990 ADVANCE CARE PLANS IN UK CARE HOME RESIDENTS: AN IMPLEMENTATION STUDY

• Published in: Age and ageing 2022-06, Vol.51 (Supplement_2)
• Main Authors: Garden, G, Usman, A, Readman, D, Storey, L, Wilkinson, L, Wilson, G, Dening, T, Gordon, A, Gladman, J
• Format: Article
• Language: English
• Subjects: Advance directives; Care plans; Clinical medicine; Cognitive impairment; Death; Death & dying; Hospitalization; Implementation; Intervention; Malnutrition; Patient admissions; Place of death; Residential care; Risk factors
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afac126.041

Abstract Introduction Research shows delivery of advance care planning (ACP) in care homes is highly acceptable, increases the proportion of residents dying in their preferred place, and reduces hospital admissions. We examined whether implementation of a service delivering ACP to care homes in Lincoln (UK) realised the research outcomes in routine practice. Method Implementation of a service undertaking ACP in care homes was evaluated using routine data. Outcomes included proportion of care homes agreeing to participate; proportion of residents agreeing to put ACPs in place; characteristics of residents with and without ACPs, and place of death of those dying with or without ACPs. Effect on hospital admissions was examined comparing pre- and post-implementation admissions in participating homes. Results Fifteen (63%) of 24 eligible care homes participated. ACPs were prepared for 404/516 (78%) residents. Those with ACPs were older, frailer, more cognitively impaired, and malnourished than those without. For those with ACPs (384/404; 95%), care homes were the preferred place of death. 219/248 (88%) of residents with ACPs who died did so in their care home compared to 33/49 who died without ACPs (33/49, (67%) (relative risk 1.35, 95%CI 1.1–1.6, p