Study Concludes that Advanced Directives are Associated with Peaceful Death

                                The 7th Annual NHDD is April 16th, 2014

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. The researchers found that 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 orders from a doctor or other health care professional, did not have any association with this aspect of the dying process. Neither did verbal communication between nurses and the patient and/or relatives.  In other words, a patient's written instructions are associated with a more peaceful passing but verbal instructions from patient are not, and written or verbal instructions from health care workers are not.  The study found "no association between the quality of dying as judged by the relative and verbal communication such as the resident expressing their wishes to the nurse or the nurse speaking with the resident concerning medical treatments at the end of life or the desired direction of care."

The study concludes:

For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

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 authors of the study concluded that their findings suggest that advanced directives should be more common and that the process of advance care planning should begin “as early as possible” for people with dementia.

National Health Care Decisions Day is April 16th.

Source: Tim Mullaney, "Chances of peaceful death are three times higher for dementia residents with an advance directive, study finds," McNight's Long Term Care News.