End-of-life care for nursing home residents with dementia

Objectives. - This study aimed to estimate the prevalence of dementia among nursing home residents at the end of life and to examine the association between a diagnosed dementia and the delivery of end-of-life care in the last month before death. Methods. - A total of 674 nursing home residents who died between 1 October 2013 and 31 May 2014 were included in the study. The prospective recruitment via a representative network of 78 nursing home physicians covered 31 different counties in France. Results. - Dementia was diagnosed in 70.9% of all nursing home decedents, including 23.1% mild to moderate dementia (mini mental state examinations [MMSE] score 10 or higher) and 47.8% severe dementia (MMSE <= 9). Dementia was associated with a less aggressive pattern of end-of-life care: residents with dementia were less likely to experience accident and emergency department visits and unplanned hospital admissions (odds ratio [OR]: 0.55; 95% confidence interval [95% CI]: 0.38-0.79), and to die in a hospital facility (OR = 0.57; 95% CI = 0.36-0.89). However, residents with dementia were also less likely to receive opioid analgesics over the course of their last month of life. Conclusion. - At the end of life, nursing home staff require specific skills and tools to address the various needs of residents with dementia and their relatives. (C) 2015 Elsevier Masson SAS. All rights reserved.