Clinicians should routinely explain ACP to older people and ensure they fully understand it prior to an ACP discussion. If there is any concern about their understanding, further exploration and documentation of their capacity using the capacity assessment framework would be necessary. However, capacity assessment is a complex iterative process that does not easily lend itself to screening methodology and requires a high level of clinical judgment.

Our findings suggest that the paternalistic model within medical care can be an expectation of some older patients and if taking a paternalistic approach we should not underestimate the trust and power that is imparted to us.

broadened to include other aspects such as making a will, financial aspects, spirituality and online accounts. That a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) be considered as a potential alternative to a standalone do not attempt cardiopulmonary resuscitation (DNACPR) process and form.The holistic Advance Care Planning policy for adults was launched in October 2022, with implementation via public information, operational frameworks, training and education, and evaluation and outcome. Conclusion A co -production inclusive approach has led to the development of a more robust policy and implementation that moves beyond traditional focus on palliative care and is instead based on a 4-component model of personal, legal, clinical and financial planning for all adults.

BackgroundPeople with dementia receive worse end of life care compared to those with cancer. The main barrier to undertaking advanced care planning (ACP) in people with dementia has been uncertainty about their capacity to engage in such discussions. Although a capacity screening tool specific to advance care planning could improve its uptake within this population, none as yet exist.AimThe primary aim of this study was to compare the ACP-CAV tool (Advance Care Planning – Capacity Assessment Vignette) to the assessment of capacity to engage in ACP using a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify other variables that may predict whether a person has capacity to engage in ACP.Methods37 Participants (mean age = 83.9; mean MMSE = 26.5) were recruited from two large retirement villages with different levels of care. Participants completed the Mini Mental State Examination (MMSE), Trail Making Tests and Geriatric Depression Scale before undertaking the capacity assessments which were video recorded to enable further analysis by 4 independent old age psychiatrists.ResultsThe ACP-CAV correctly assessed the capacity of 65% of the cases when compared to the MacCAT-T method. MMSE was the only variable found to predict capacity.ConclusionCapacity assessment should be routinely conducted prior to discussing ACP with older people, in particularly those with cognitive impairment. However, it is a complex iterative process that does not easily lend itself to screening methodology and requires a high level of clinical judgement.