Aim To identify and appraise influencing factors associated with acute care utilisation amongst nursing home residents with advanced dementia in final three months of life with view to inform adaptation of an existing conceptual model.

To evaluate effectiveness of identified interventions influencing acute care utilisation amongst this cohort.

Methods Six electronic databases(MEDLINE, EMBASE,CINAHL, PsycINFO, Web of Science, Cochrane Library) were

searched from inception through March 2015 for studies pertaining to the above research question supplemented by hand-searching selected journals, reference and citation tracking, contact with experts and grey literature search. Following a systematic process, key studies were identified, data extracted and results collated. Strength of evidence was determined according to quality, quality of studies and consistency of findings for individual factors and assigned as low, moderate and high to inform a conceptual model. Results were thereafter harmonised using the process of narrative synthesis.

Results No intervention studies meeting criteria for inclusion in the review were identified. Eight studies were identified

reporting four demographic, three clinical and five environmental factors across three countries and 5 02 323 individuals. High strength evidence was assigned for effect of four factors upon risk of acute care utilisation in final months of life; two increased risk (black ethnicity, co-morbidity {previous stroke}); two reduced risk (insurance status, presence of advance decision). The remaining were assigned moderate (two factors) and low (seven factors) strengths of evidence respectively impacting upon all domains of the model.

Conclusion A myriad of inter-related factors influence acute care utilisation in nursing home residents with advanced

dementia approaching end of life. Further interrogation of views of health-care proxies, professionals and other

stakeholders may elucidate additional influences upon decision making process, enhancing understanding.

Findings may assist in informing clinical, organisational and policy initiatives to attenuate unnecessary and burdensome transitions in this population.