Research focus

Advance care planning for nursing home residents with dementia: policy vs. practice

Despite the potential benefits of ACP for nursing home residents with dementia, the authors of this study highlight that hardly any research has focused on the involvement of residents/families in ACP and that ACP is rarely realised for these people. Their research aimed to evaluate the ACP policy for people with dementia in nursing homes and to gain insight into the involvement of residents with dementia and their families in ACP.

Advance care planning (ACP) provides a framework for discussing and documenting care preferences in preparation for situations in which a person loses the cognitive capacity to make decisions.

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It can be particularly valuable in assisting people in the early stages of living with a dementia, supported by their families, to document their preferences for care at the later stages of their illness. While the potential benefits of ACP are widely acknowledged, there remain gaps in the research evidence on ACP and challenges in implementing ACP in practice. The recently-published study described below address these issues.


Ampe S, Sevenants A, Smets T et al (2016) Advance care planning for nursing home residents with dementia: policy vs. practice. Journal of Advanced Nursing. 72, 3, 569-581

Despite the potential benefits of ACP for nursing home residents with dementia, the authors of this study highlight that hardly any research has focused on the involvement of residents/families in ACP and that ACP is rarely realised for these people. Their research aimed to evaluate the ACP policy for people with dementia in nursing homes and to gain insight into the involvement of residents with dementia and their families in ACP.

In this observational cross-sectional study of 20 nursing homes in Belgium, an audit assessed the views of the nursing homes’ staff on the ACP policy. In addition, individual conversations were analysed with ‘ACP criteria’ (realisation of ACP) and the ‘OPTION’ instrument (involvement of residents/families). The findings identified that the nursing homes generally met three quarters of the pre-defined criteria for ACP policy.

ACP was explained and substantively discussed in almost half of the conversations but, generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The authors conclude that the evaluations of the policy are promising, but the actual practice of implementing ACP needs improvement. They recommend further assessment of policy and practice and that further research should focus on communication interventions for implementing ACP in everyday practice.

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