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O-71 Not competent but not silent – a pilot study of ACP with dementia patients
  1. Karen Detering,
  2. Scott A Fraser,
  3. K Whiteside and
  4. William Silvester
  1. Respecting Patient Choices – Austin Health, Victoria, Australia

Abstract

Background Dementia is the greatest cause of disability in older Australians and the third leading cause of disability burden. Literature suggests, people with dementia experience suboptimal EOLC due to a loss of capacity over medical decision making.

Aim To determine the feasibility of ACP with dementia patients in inpatient and outpatient settings.

Methods Consecutive Austin Health dementia patients were offered ACP with an ACP facilitator. Dementia patients were included to the best of their ability. Age and gender matched controlled patients (no dementia) persons offered ACP by same facilitators.

Results ACP completion rates were similar between groups (control 55%, dementia 47%) with the exception of outpatients where low completion (16%) is reflected in few documents. There was no difference between the numbers of control (34%) or inpatient (39%) advance directives completed, although the latter were predominantly non-competent. Advance directives for non-competent were more likely to request not want CPR/LPT (Life-Prolonging-Treatment). There was no difference between the total number of MEPOAs (Control 39%, inpatient 34%) although the dementia groups were completed prior. Dementia carers found the conversation useful and 86% will discuss wishes with the patient’s doctor and other family members.

Discussion Dementia patients are underrepresented with regards to completion of ACP leading to invasive and sub-optimal EOLC. There is the perception that dementia precludes ACP however, this study demonstrates that conversations with family members and including the patient leads to similar outcomes with other groups.

Conclusion ACP with people with dementia, and their family is feasible in an inpatient setting.

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