Advance Care Plans in UK care home residents: a service evaluation using a stepped wedge design

Garden, Gill; Usman, Adeela; Readman, Donna; Storey, Lesley; Wilkinson, Lindsey; Wilson, Graham; Dening, Tom; Gordon, Adam L; Gladman, John

Abstract

Introduction
Advance care planning (ACP) in care homes has high acceptance, increases the proportion of residents dying in place and reduces hospital admissions in research. We investigated whether ACP had similar outcomes when introduced during real-world service implementation.
Methods
A service undertaking ACP in Lincoln, UK care homes was evaluated using routine data. Outcomes were proportion of care homes and residents participating in ACP; characteristics of residents choosing/declining ACP; and place of death for those with/without ACP. Hospital admissions were analysed using mixed-effects Poisson regression for number of admissions, and a mixed-effects negative binomial model for number of occupied hospital bed days.
Results
15/24 (63%) eligible homes supported the service, in which 404/508 (79.5%) participants chose ACP. Residents choosing ACP were older, frailer, more cognitively impaired and malnourished. 384/404 (95%) residents choosing ACP recorded their care home as their preferred place of death: 380/404 (94%) declined cardiopulmonary resuscitation. Among deceased residents, 219/248 (88%) and 33/49 (67%) with and without advance care plan respectively died in their care home (relative risk 1.35, 95%CI 1.1-1.6, p<0.001). Hospital admission rates and bed occupancy did not differ after implementation.
Discussion
79.5% participants chose ACP. Those doing so were more likely to die at home. Many homes were unwilling or unable to support the service. Further research should consider how to enlist the support of these homes. Hospital admissions were not reduced and may not be an appropriate outcome metric for ACP in care homes.

Citation

Garden, G., Usman, A., Readman, D., Storey, L., Wilkinson, L., Wilson, G., Dening, T., Gordon, A. L., & Gladman, J. (2022). Advance Care Plans in UK care home residents: a service evaluation using a stepped wedge design. Age and Ageing, 51(3), Article afac069. https://doi.org/10.1093/ageing/afac069

• Journal Article Type: Article
• Acceptance Date: Feb 14, 2022
• Online Publication Date: Mar 29, 2022
• Publication Date: 2022-03
• Deposit Date: Feb 24, 2022
• Publicly Available Date: Apr 7, 2022
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 51
• Issue: 3
• Article Number: afac069
• DOI: https://doi.org/10.1093/ageing/afac069
• Keywords: Keys words: Advance Care Plans; Care Home residents; Hospital Admissions
• Public URL: https://nottingham-repository.worktribe.com/output/7506048
• Publisher URL: https://academic.oup.com/ageing/article/51/3/afac069/6555262