Advance care planning within residential care for older people, a review

Aim: To review the process and components of and participants involved with ACP in the residential care for older people (65 years of older). Design: Systematic review using electronic database searches (MEDLINE, Embase, CINAHL), hand searching the Journal of the American Geriatric Society and lead author searches. Search terms included: advance care planning, residential care, residential facilities, elderly, aged, aged, 80 and over. Measurement: The process, components and participants were systematically abstracted and summarized into tables. Independent data analysis was performed and discussed by three authors. Results: This review included 25 publications from 19 studies: nine surveys, two retrospective cohort study, two mixed method studies, two descriptive qualitative studies, one case study, one four stage implementation project, one quasi experimental design and one randomized controlled trial. The process of ACP anticipated health problems, took decisional capacity into consideration, discussed treatment preferences, documented these on specific ACP forms or documents, implemented preferences upon deterioration and could be systematically reviewed. The most common components were cardiopulmonary resuscitation, hospitalization, artificial nutrition and fluids. Nurses most often participated in ACP with residents and their family. Other care professionals involved were social workers, general practitioners, nurse practitioners, physicians, clinical nurse consultants, care assistants and care home managers. Conclusion: ACP requires adequate decisional capacity but no reliable strategy has been identified to combat this barrier. ACP discussions seem to focus on care preferences and much less on personal values and understanding of the resident.status: publishe