Palliative care for older people - World Health Organization ...

The application of advance care planning incountries in the European Region needs to beevaluated and must consider the different culturesand values, the terms used and the differencesbetween health care systems when interpreting theevidence. For example, legislation in the United Statesof America requires that all individuals admitted toa care home be offered advance care planning. Inaddition to facilitating individual choice (Box 13.1),advance care planning may reduce the cost of healthcare at the end of life (Box 13.2).© Sue HallBox 13.1. Preferred Priorities for Care in the United KingdomThe Preferred Priorities for Care (7) is a document held by the person who is to receive care. It was developedin the United Kingdom and designed to facilitate choice in relation to end-of-life issues. People becomeempowered by sharing important information with all professionals involved in their care. The explicit recordingof the wishes of people receiving care and their caregivers can form the basis of care planning in multidisciplinaryteams and other services, minimizing inappropriate admissions and interventions. In care homes for olderpeople, this is an opportunity for residents and staff to work together to develop advance care plans. Residentscan initiate the plan at any time, and this will help staff members to follow their wishes and act as an advocateif the resident loses capacity towards the end of his or her life. Early evaluations suggest that such planssignificantly influence people receiving care in their preferred place of care at the end of life, without significantchanges in the services needed.Sources: The Preferred Priorities for Care (PPC) document: guidelines for health and/or social care staff (8) and Preferred Priorities for Care (9).Box 13.2. Advance directives in nursing homesStaff in local hospitals and nursing homes, residents and their families in Ontario, Canada were educatedin advance planning. Three nurses from care homes attended a two-day workshop and then disseminatedknowledge to other staff in the home. This resulted in fewer residents being sent to hospital and a reductionin the cost of hospital care from Can$ 1772 per resident in homes that used this approach versus Can$ 3869homes not using it. Total health care and implementation costs were also lower: Can$ 3490 per resident versusCan$ 5239. This includes the cost for hospitalization, drugs and costs related to implementing the advancecare planning.Source: Molloy et al. (10).42