161Advance Care Plans - A Day Hospital Perspective

Abstract

Background: Advance Care Plans (ACPs) aim to involve the patient in all aspects of their care, and are known to improve the quality of end of life care. They may be of particular benefit in addressing the needs of people with dementia. We aimed to examine the presence or absence of ACPs in a frail, older population. Methods: 40 randomly selected charts were retrospectively reviewed of patients who had been attending a day hospital for at least two years, with an established diagnosis of a neurodegenerative disorder. Results: Of the 40 patients reviewed, the most common diagnosis was Parkinson's Disease with or without dementia (15/40) followed by mixed type dementia (7/40), vascular dementia (7/40), Alzheimer's dementia (5/40), undifferentiated dementia (4/40) and frontotemporal dementia (2/40). The median age was 85 years (range 68-100), and 38/40 were residing in their own home, the remaining two patients were nursing home (NH) residents. The median duration of diagnosis was 4 years (range 1-32) and the median Clinical Frailty Scale (CFS) was 6 (range 4-8). 11/40 had a hospitalisation in the preceding year. 3/40 patients had a written advance care plan in their notes. A discussion had occurred in a further 2/40, but no formal outcomes had been documented. Neither of the two NH residents had an ACP, nor had any of those who had been hospitalised. Conclusions: The day hospital could be an ideal setting to involve patients and their families in discussing future wishes and care considerations in this particularly frail cohort. Consideration should be given to exploring the barriers to advance care plans, within both the medical profession and the general population. When reviewing these patients in the day hospital, there may scope to introduce specific care planning tools such as the Goals of Care Designation document.