Skip Navigation



Age and Ageing Advance Access published online on June 28, 2006
Age and Ageing, doi:10.1093/ageing/afl063
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow supplementary data
Right arrow All Versions of this Article:
35/6/581    most recent
afl063v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Caplan, G. A.
Right arrow Articles by Willett, W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Caplan, G. A.
Right arrow Articles by Willett, W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received November 22, 2005
Accepted April 25, 2006

Article

Advance care planning and hospital in the nursing home

Gideon A. Caplan 1 *, Anne Meller 2, Barbara Squires 3, Stella Chan 4, and Wendy Willett 5

1 Prince of Wales Hospital, Post Acute Care Services, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
2 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
3 Aged Care Benevolent Society, Sydney, NSW, Australia
4 South Eastern Sydney Illawarra Area Health Service, Sydney, NSW, Australia
5 Anglicare Chesalon Aged Services, Sydney, NSW, Australia

* To whom correspondence should be addressed.
Gideon A. Caplan, E-mail: g.caplan{at}unsw.edu.au


  Abstract

Background: The number of nursing home residents (NHRs) in hospital is increasing although hospital admission may be deleterious to their health.

Objective: To evaluate a system of educating residents, their families, staff and general practitioners about outcomes of dementia, advance care planning (ACP) and hospital in the home.

Methods: We employed one clinical nurse consultant, who utilised the ‘Let Me Decide’ Advance Care Directive. The intervention area consisted of two hospitals and the 21 nursing homes (NHs) around them compared with another, geographically separate, hospital and the 13 homes around it. We conducted a controlled evaluation monitoring emergency admissions to hospital.

Results: Emergency calls to the ambulance service from intervention NHs decreased (intervention versus control; -1 versus +21%; P = 0.0019). The risk of a resident being in an intervention hospital bed for a day compared with in a control hospital bed, per NH bed, fell by a quarter from being initially similar [Relative Risk (RR) = 1.01; 95% confidence interval (CI) 0.98-1.04; P = 0.442] to being lower (RR = 0.74; 95% CI 0.72-0.77; P<0.0001). There was no significant change in mortality in the intervention homes, but in the control homes mortality rose in the third year to be 11.2 per 100 beds higher than in the intervention area (P<0.05).

Conclusion: ACP and hospital in the home can result in decreased hospital admission and mortality of NHRs.

Keywords: nursing homes, advance care planning, living with advance care directive, dementia, hospitalisation, home care services--hospital based, elderly.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 DementiaHome page
A. E. Meller and G. A. Caplan
Let someone else decide?: Development of an advance care planning service for nursing home residents with advanced dementia
Dementia, August 1, 2009; 8(3): 391 - 405.
[Abstract] [PDF]

Home page
 J Aging HealthHome page
B. S. Black, L. A. Fogarty, H. Phillips, T. Finucane, D. J. Loreck, A. Baker, D. M. Blass, and P. V. Rabins
Surrogate Decision Makers' Understanding of Dementia Patients' Prior Wishes for End-of-Life Care
J Aging Health, June 1, 2009; 21(4): 627 - 650.
[Abstract] [PDF]

Home page
 BMJHome page
S. Purdy and T. Griffin
Reducing hospital admissions
BMJ, January 5, 2008; 336(7634): 4 - 5.
[Full Text] [PDF]

Home page
 Age AgeingHome page
C. M. P. M. Hertogh
Advance care planning and the relevance of a palliative care approach in dementia.
Age Ageing, November 1, 2006; 35(6): 553 - 555.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.