Background Gericare is a community programme in Singapore that supports nursing home (NH) residents with palliative care needs. Advanced Care Planning (ACP) is introduced to the residents after enrolment into Gericare. Although ACP is beneficial, little is known if ACP completion among patients with life-limiting illnesses has any negative association with their actual prognosis.
Method We conducted a retrospective cohort analysis of 724 residents enrolled into Gericare from 8 nursing homes between July 2019 and May 2022. Deceased patients (N = 294) were compared to alive patients (N = 430) in terms of demographics, disease types, ACP completion rates and preferences. ACP completion in relation to Enrolment till death (ETD) among deceased residents is examined.
Results The mean age was 81.8 years old. Advanced neurological disease (N = 339) and severe frailty (N = 171) were two most common life-limiting illness. ACP completion rate among the deceased is higher (81%) than that among the alive (53%). Deceased patients with completed ACP were older at demise on average (83.4) than that those without ACP (80.9); their average ETD is statistically significantly (p-value 0.00025) longer (204 days), than those without ACP (98 days). Those who opted for full treatment had the shortest ETD on average (88 days), compared to those who chose comfort care (173 days) and limited intervention (255 days).
Conclusion Our preliminary analysis has found NH residents enrolled into Gericare before death have higher ACP completion rate than those still alive. Though residents with poorer prognosis are more likely to complete ACP earlier, our study illustrated that ACP completion did not worsen actual prognosis, given longer ETD among patients with completed ACP, which advocates for early enrolment of suitable NH residents into palliative care programmes like Gericare.
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