Senior in hospital bed

The use of a new advance care planning (ACP) model in Canadian nursing homes yielded high ratings by residents or their proxies, and was linked to decreased use of antimicrobials, investigators say.

ACP discussions are necessary but typically “suboptimal” in long-term care, the researchers said. In response, they tested an approach called Better Targeting, Better Outcomes for Frail Elderly Patients (BABEL) in 29 facilities across three provinces, Ontario, Manitoba and Alberta. 

The intervention included a structured, 60-minute discussion between individual residents, proxy decision-makers and nursing home staff. The discussion confirmed the proxy’s identity and role; prepared the proxy for medical emergencies; explained the resident’s clinical condition and prognosis; and ascertained the resident’s preferred “philosophy” to guide decision-making. The resident’s wishes in the case of specific medical emergencies were also determined. 

Results were compared with a control group of nursing homes that continued with their usual ACP processes. The intervention resulted in fivefold greater likelihood that the ACP session would be rated as comprehensive by respondents. There was no perceived difference between the cohorts in comfort in dying, however.  

Antimicrobial use, a secondary study outcome, was significantly lower in facilities that participated in the intervention. 

“Often people assume that a non-capable resident can’t participate, but there are other ways of communicating and understanding an individual’s preferences,” researcher George Heckman, M.D., of the University of Waterloo in Ontario, said in a statement.

The time taken for the intervention is “an opportunity to get it right,” he added.“BABEL certainly seems to help residents and substitute decision-makers with these otherwise challenging conversations and paves the way for more timely and comprehensive palliative care,” he concluded.

The study was published in the journal Age and Ageing.

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