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Dying peacefully in residents with dementia in long-term care facilities: a good quality indicator?

Roo, M.L. de, Steen, J.T. van der, Galindo Garre, F., Noortgate, N. van den, Onwuteaka-Philipsen, B.D., Deliens, L., Francke, A.L. Dying peacefully in residents with dementia in long-term care facilities: a good quality indicator? European Journal of Palliative Care: 2013, p. 87. Abstract. In abstractbook. EAPC 2013. 13th World Congress of the European Association for Palliative Care (EAPC). 30 may - 2 june 2013, Prague.
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Background: Little is known about whether people with dementia die peacefully. This may be influenced by the (palliative) care provided. If so, dying peacefully may serve as a quality indicator for palliative care in dementia. Aims: (1) To describe the proportion of residents with dementia in long-term care facilities that dies peacefully. (2) To explore whether the available quality indicator “the percentage of relatives who indicate that the patient died peacefully” captures quality differences between different care facilities and hence is a discriminative and useful indicator. Methods: We used written questionnaires about quality of dying completed by families and physicians in the Dutch End of Life in Dementia study, performed in 34 long-term care facilities in the Netherlands between January 2007 and July 2010. The percentage of residents dying peacefully was calculated for each facility and Generalized Estimating Equation models were used to explore associations between long-term care facility characteristics and the proportion of peaceful deaths. Results: Relatives of 233 residents with dementia indicated that the resident died peacefully in 56% of cases. This percentage ranged from 33-85% across facilities. This range
points to the discriminative power of this quality indicator, enabling a comparison of care provided by long-term care facilities to residents with dementia. Residents were more likely to have died peacefully in facilities with a moderate (versus no) “perceived influence of religious affiliation on end-of-life decision making”, and when “family finds staffing sufficient”. Conclusion: According to their relatives, about half of Dutch people with dementia die peacefully. This proportion varies between care facilities. Differences in scores appeared to be related to characteristics of the long-term care facilities, which suggests that the percentage of residents with dementia dying peacefully is an indicator of the quality of care in this setting.