Advance Care Planning in Patients with Moderate to Advanced Dementia

Introduction

Advance care planning is a cornerstone of holistic care in patients with dementia. I conducted a quality improvement project (QIP) in Musgrave Park Hospital on the Orthogeriatrics Ward. The QIP focused on advance care planning in patients with moderate to advanced dementia.

Method

The target cohort was post-operative fracture patients with a formal diagnosis of dementia. Patients with moderate to advanced dementia were identified using the clinical frailty scale. Once a patient was identified, I ascertained whether the patient had capacity. If the patient was not deemed to have capacity, questions were deferred to the next of kin (NOK). The patient or NOK was asked ‘if an ACP was in place?’ and if an ACP was not in place, they were the asked ‘if they were aware of what an ACP is?’.

Results

I collected data between 1^st March 2023 and 1^st April 2023. Eighteen patients were identified. No patients were deemed to have capacity and therefore, all questions were deferred to their NOK. No patients had an ACP in place and only one NOK was aware of what an ACP is.

Conclusion

The data collected showed that no patients had an ACP in place and that there was a significant lack of education regarding what an ACP is. This lack of understanding concerning what an ACP entails may be preventing ACPs from being completed in the community. I designed a leaflet which summarised the key aspects of advance care planning. These leaflets will be handed out to patients or their NOKs. I will follow up on these patients to see if education has led to an ACP being put in place.