Advance care planning in different settings for people with dementia: A systematic review and narrative synthesis

Abstract

BackgroundAdvance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established.AimWe conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated.MethodsA search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals.ResultsOf 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance.ConclusionFuture research should focus on ways to involve people with dementia in decision-making through supported means.

A systematic review of interventions to improve acute hospital care for people with dementia

“…One was a cluster-randomised controlled trial [32], and two were controlled clinical trials [33,34]. Seven of the studies were systematic reviews [15,16,[35][36][37][38][39]. The systematic reviews were published in 2015 [36] (n = 1), 2017 [35] (n = 1), 2019 [15,16,39] (n = 3) and 2020 [37,38].…”

“…Of the interventional studies, ve studies were conducted in Australia [24,25,30,31,34], three in the United States [22,26,32], two in the United Kingdom [23,28] and each one in Canada [33], Germany [29] and Switzerland [27]. Four systematic reviews were carried out in the UK [15,16,35,36] and three in Australia [37][38][39]. The included interventional studies presented a range of interventions for people with dementia in the acute hospital setting, including educational interventions for healthcare staff [23,26,28,30,33] (n = 5), for healthcare staff and non-clinical staff [31] (n=1) or for volunteers working with people with dementia in the hospital [29] (n = 1).…”

“…Further studies investigated a delirium management programme for people with cognitive impairment [27] (n = 1) and a special non-pharmacological intervention [22] (n = 1). The systematic reviews focussed on educational interventions [15,35] (n = 2), on volunteer programmes [38] (n=1), on special care units for people with dementia [16] (n = 1), on palliative care consultation services for people with advanced dementia [39] (n=1), on interventions to improve caregiver readiness [37] (n=1), and on inpatient rehabilitation interventions for people with dementia after hip fracture on surgical units [36] (n = 1). Table 1 provides information about the characteristics of included studies.…”

“…Another study compared a transition programme conducted by advanced practice nurses with the help of 'resource nurses' (upskilled registered nurses) and an augmented standard care programme (research assistants communicating cognitive screening results to staff) [32]. One systematic review focused on interventions providing palliative care consultation services by specialised healthcare professionals for people with advanced dementia with the aim to in uence advance care planning [39].…”

The compound role of a coordinator for home-dwelling persons with dementia and their informal caregivers: A qualitative feasibility study of the LIVE@Home.Path trial

“…In a multi-case study of ten cases, Smebye et al [13] increasingly common within dementia care [26]. Also within this concept, exclusion of the person with dementia, often without giving account for why, was the most frequent finding in a systematic review, including 30 articles [27]. As the available support for persons with dementia is getting more specialized and individually adaptable, the amount of decisions being made concerning care and support is increasing accordingly.…”