ADHERENCE TO ADVANCE CARE PLAN IN AN ENDOF-LIFE PROGRAM FOR ELDERLY FROM NURSING HOMES IN HONG KONG

• Published in: Innovation in aging 2017-07, Vol.1 (suppl_1), p.158-159
• Main Authors: Yuk, K.D., Ming Ma, H., Au, K., Leung, M., Ng, J., Cheng, H., Yin Yung, S., Hui, E.
• Format: Article
• Language: English
• Subjects: Abstracts
• ISSN: 2399-5300; 2399-5300
• DOI: 10.1093/geroni/igx004.623

Background: In Hong Kong, dying in nursing homes will trigger a Coroner’s referral, and over 11,000 nursing home residents were sent to acute hospitals to die every year. End-of-life (EOL) care in Hong Kong developed rapidly in recent years. An EOL Program for nursing home residents was established, aiming to promote advance care plan (ACP) discussions and facilitate care in place. Objective: To evaluate the adherence to patients’ ACP preferences, and where and how their death occurred. Design: Retrospective clinical audit of data from clinical notes and electronic patient records for the period October 2015 to March 2016. Results: 83 nursing home residents were enrolled into the program during this period, with a mean age 92.4 years (median=93) and 87.8% of which had dementia. Advance care plans were established in all residents, mostly with their next-of-kins. All (100%) indicated their preference of do-not-attempt CPR (DNACPR). 32.9% indicated their preference against the use of both naso-gastric tube (NGT) feeding and non-invasive positive pressure ventilators (NIPPV). 51 participants (61.4%) accepted using NGT as a mode of feeding. During the patient journeys, adherence to ACP regarding NGT and NIPPV use were both 98.8% respectively. There were 35 (42.2%) deaths within this 6-month period, and the average duration of care per death case was 120.7 days (median=125). 26 (74.3%) of these deaths occurred in an extended care hospital, in particular 15 (42.9%) participants died in designated EOL wards. Conclusion: Participants of this EOL program had their ACP preferences honored and deaths occurred in place.