Managing advanced dementia, advance care planning for dementia patients

Abstract

Aims: To trial a staff education and training program designed to facilitate the adoption of a palliative care approach for residents with end stage dementia in aged care facilities. Methods: A cluster randomised controlled trial of 12 residential aged care facilities in regional and rural setting with 530 residents in the intervention and 520 in the control facilities. The intervention was delivering a tailor made evaluated education tool and training program for aged care staff conducted in two stages. The outcomes recorded were Incidence of presentations to Emergency Department, hospital admissions and mortality. Results: Post intervention a signifi cant difference was observed in Emergency presentations χ2 = 18.8, p \u3c 0.0001; OR = 0.44; 95% CI 0.31–0.65, 8.8% of intervention residents versus 17.88% of control residents. (The intervention group had a −5.88% reduction in Emergency presentations and control group an increase of 14.6%.) Similar results were found for the number of hospital admissions (intervention 6.9% versus control 11.3%), χ2 = 6.16, p \u3c 0.013; OR = 0.58 95%CI 0.38 to 0.89. The mortality was not signifi cantly different p = 0.6. Conclusions: A specifi c education and training program can signifi cantly reduce emergency presentations and hospital admissions without compromising resident care or mortality. Training is a crucial and cost effective way to improve care at end of life in dementia