Advance directives in European long-term care facilities: A cross-sectional survey

Paula Andreasen, Ulla Harriet Finne-Soveri, Luc Deliens, Lieve van den Block, Sheila Payne, Giovanni Gambassi, Bregje D. Onwuteaka-Philipsen, Tinne Smets, Eero Lilja, Violetta Kijowska, Katarzyna Szczerbińska

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Methods: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member. LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country. Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. Results: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, â € Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%. LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Conclusion: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.
LanguageEnglish
JournalBMJ Supportive & Palliative Care
DOIs
Publication statusPublished - 2019

Cite this

Andreasen, P., Finne-Soveri, U. H., Deliens, L., van den Block, L., Payne, S., Gambassi, G., ... Szczerbińska, K. (2019). Advance directives in European long-term care facilities: A cross-sectional survey. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2018-001743
Andreasen, Paula ; Finne-Soveri, Ulla Harriet ; Deliens, Luc ; van den Block, Lieve ; Payne, Sheila ; Gambassi, Giovanni ; Onwuteaka-Philipsen, Bregje D. ; Smets, Tinne ; Lilja, Eero ; Kijowska, Violetta ; Szczerbińska, Katarzyna. / Advance directives in European long-term care facilities: A cross-sectional survey. In: BMJ Supportive & Palliative Care. 2019.
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title = "Advance directives in European long-term care facilities: A cross-sectional survey",
abstract = "Background: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Methods: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member. LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country. Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. Results: In total, 32.5 {\%} of the 1384 deceased LTCF residents had a written advance directive with a range from 0{\%} to 77 {\%} between countries. The proportion of the most common advance directive, {\^a} € Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0{\%} to 75{\%}. LTCF type (OR 2.86 95{\%} CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95{\%} CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Conclusion: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.",
author = "Paula Andreasen and Finne-Soveri, {Ulla Harriet} and Luc Deliens and {van den Block}, Lieve and Sheila Payne and Giovanni Gambassi and Onwuteaka-Philipsen, {Bregje D.} and Tinne Smets and Eero Lilja and Violetta Kijowska and Katarzyna Szczerbińska",
year = "2019",
doi = "10.1136/bmjspcare-2018-001743",
language = "English",
journal = "BMJ Supportive & Palliative Care",
issn = "2045-435X",
publisher = "BMJ Publishing Group",

}

Andreasen, P, Finne-Soveri, UH, Deliens, L, van den Block, L, Payne, S, Gambassi, G, Onwuteaka-Philipsen, BD, Smets, T, Lilja, E, Kijowska, V & Szczerbińska, K 2019, 'Advance directives in European long-term care facilities: A cross-sectional survey', BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2018-001743

Advance directives in European long-term care facilities: A cross-sectional survey. / Andreasen, Paula; Finne-Soveri, Ulla Harriet; Deliens, Luc; van den Block, Lieve; Payne, Sheila; Gambassi, Giovanni; Onwuteaka-Philipsen, Bregje D.; Smets, Tinne; Lilja, Eero; Kijowska, Violetta; Szczerbińska, Katarzyna.

In: BMJ Supportive & Palliative Care, 2019.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Advance directives in European long-term care facilities: A cross-sectional survey

AU - Andreasen, Paula

AU - Finne-Soveri, Ulla Harriet

AU - Deliens, Luc

AU - van den Block, Lieve

AU - Payne, Sheila

AU - Gambassi, Giovanni

AU - Onwuteaka-Philipsen, Bregje D.

AU - Smets, Tinne

AU - Lilja, Eero

AU - Kijowska, Violetta

AU - Szczerbińska, Katarzyna

PY - 2019

Y1 - 2019

N2 - Background: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Methods: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member. LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country. Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. Results: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, â € Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%. LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Conclusion: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

AB - Background: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Methods: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member. LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country. Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. Results: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, â € Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%. LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Conclusion: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85066084286&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31113800

U2 - 10.1136/bmjspcare-2018-001743

DO - 10.1136/bmjspcare-2018-001743

M3 - Review article

JO - BMJ Supportive & Palliative Care

T2 - BMJ Supportive & Palliative Care

JF - BMJ Supportive & Palliative Care

SN - 2045-435X

ER -