Chances of peaceful death are three times higher for dementia residents with an advance directive, study finds

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Hospice is growing fastest in skilled nursing facilities, new report shows
Hospice is growing fastest in skilled nursing facilities, new report shows

Dying nursing home residents who have dementia display significantly less fear and anxiety if they have a written advance directive in place, according to recently published research findings.

Investigators analyzed responses from 69 Belgian nursing homes, focusing on the roughly 200 residents who had dementia at their time of death. Those residents who had completed a written advance directive were three times more likely to have experienced less fear and anxiety in their last days, the researchers determined. They reached this conclusion based on input from residents' family members, which used the Comfort Assessment in Dying with Dementia scale.

Having a do-not-resuscitate order in particular related to a calmer process of dying, the researchers found. The existence of written advance general practitioner orders did not have any association with this aspect of the dying process. Neither did verbal communication between nurses and the patient and/or relatives.

The study was not designed to determine why advance directives had a positive emotional effect for the dying residents, but the researchers offered some possible explanations. One is that relatives, assured that their loved one was receiving preferred types of care, projected a greater sense of calmness onto the resident. Another is that completing an advance directive triggers a psychological process that helps the resident die in peace.

Given that only 17.5% of the residents in this study had a written advanced directive, the findings suggest that ADs should be more common and that the process of advance care planning should begin “as early as possible” for people with dementia, the authors concluded.

The findings appear in PLOS One.

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