BackgroundEnd-of-life-care is often poor in individuals with dementia. Advanced care planning (ACP) has the potential to improve end-of-life care in dementia. Commonly ACP is completed in the last six months of life but in dementia there may be problems with this as decision-making capacity and ability to communicate necessarily decrease as the disease progresses. Choosing the right time to discuss ACP with people with dementia may be challenging given the duration of the illness may be up to nine years.AimsTo explore the acceptability of discussing ACP with people with memory problems and mild dementia shortly after diagnosis.MethodsIn-depth interviews were conducted with 12 patients and eight carers who had participated in ACP discussions and six staff members from a memory clinic and a community mental health team who had either conducted or attended the discussions for training purposes.ResultsPatients and carers found ACP a positive intervention that helped them think about the future, enabled people with dementia to make their wishes known, and resulted in their feeling relieved and less worried about the future. The importance of sharing the ACP documentation between health service providers was highlighted.ConclusionsThis qualitative evaluation of ACP in early dementia has encouragingly positive results which support the wider application of the intervention in memory services and community mental health teams. Strategies are suggested to support the implementation of ACP further in clinical practice.

Background There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. Methods In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. Results Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. Conclusions At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registrationNCT04401254 May 26, 2020.

There are major problems in end-of-life care for people with dementia. Staff and relatives, particularly in care home settings (where often a signifi cant majority of residents with dementia lack capacity), can fi nd discussion about end of life care especially diffi cult to bring up. Diffi culties relating to mental capacity and the often unpredictable decline with dementia in the last few months mean that dementia-specifi c approaches need to be developed to meet the needs of people with dementia and their families. This project recruited former carers, who had looked after a relative with dementia until they died, to aid staff and relatives in discussing advance care planning. on 7 April 2019 by guest. Protected by copyright.

The Modernisation Initiative End of Life Care Programme aim is to achieve excellent end of life care for all in Lambeth and Southwark, including those with dementia and their carers.Earlier diagnosis of dementia can enable the person affected to indicate their future care and treatment preferences through completing a future care plan. Later, in the more advanced stages of dementia, there may be deterioration in cognitive functioning which affects people's capacity to express their wishes.Prior to the intervention, the views and opinions were sought from service users and staff. These were of the usefulness of the intervention, the questions in the document as well as style and language.An implementation study was set up to deliver future care planning to people who received a diagnosis of dementia though a new memory service.The Nurse Advisor developed and delivered training for mental health care professionals in future care planning using interactive forum theatre and role play. This training was conducted and evaluated as part of the induction of a new memory service as well as to Community Mental Health teams for older adults.Following training, facilitation and role modelling by the Nurse Advisor, people with dementia were offered the opportunity to plan for their future. Staff were supported in reflective learning sessions.Following ethical approval, the researcher conducted interviews with people with dementia and their families to evaluate the acceptability and effectiveness of the future care planning conversations and their feelings about these conversations.