Advance care planning in Japanese nursing homes. Issue 1 (1st June 2011) - Nishikawa, M
Abstract : Background: Japan has the highest rate of ageing worldwide. In Japan, the Ministry of Health, Labour and Welfare is concerned that there are insufficient doctors to care for the elderly in nursing homes and also insufficient advance care planning (ACP). In Japan, the study of the ACP at the nursing home just still started. Purpose: The study aim was to evaluate the utility of ACP at the nursing home, supported by an ACP clinician trained in the National Centre for Geriatrics and Gerontology in Japan. Methods: Out of 80 families of nursing home residents, 51 participated in this study with all attending a lecture about ACP. We investigated the following: Do the families of the residents prefer the nursing home as the place for the residents' last moments? Would the families like the residents to use mechanical ventilators, gastric feeding tubes, blood transfusion, intravenous infusion or sedative drugs in their terminal states? Do the families prefer to care for the residents on their deathbeds at the nursing home, even if death certificates are not promptly issued because the nursing home does not have any full-time doctors? Results: Intervention by a trained ACP clinician significantly increased the number of families who chose terminal care at the nursing home, and the nursing home as the place for the residents' last moments, even if death certificates are not promptly issued (p<0.01). Conclusion: A trained ACP clinician is useful for ACP in the nursing home.