TY - JOUR
T1 - Effectiveness of Advance Care Planning for End-of-Life Outcomes in Nursing Home Residents With Dementia
T2 - A Systematic Review and Meta-Analysis
AU - Lin, Yi Jyun
AU - Chen, Yi Jhen
AU - Ling, Daphne I.
AU - Fang, Jing Ru
AU - Wu, Jheng Yan
AU - Lo, Yu Tai
N1 - Publisher Copyright:
© 2025 Post-Acute and Long-Term Care Medical Association.
PY - 2026/1
Y1 - 2026/1
N2 - Objectives To identify the components of advance care planning (ACP) programs implemented in nursing homes, evaluate the range of associated end-of-life (EoL) outcomes for individuals with dementia and their caregivers, and assess their overall effectiveness. Design Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. Setting and Participants Individuals with dementia in nursing homes, their caregivers, and staff members. Methods We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception to December 31, 2024. Studies were eligible if they evaluated ACP interventions delivered in nursing home settings and reported EoL outcomes for individuals with dementia and/or their caregivers. Risk of bias was assessed using the Cochrane ROB 2.0 tool for RCTs and the ROBINS-I tool for observational studies. Certainty of evidence was evaluated using the GRADE framework. Results Ten studies, all conducted in the United States, the United Kingdom, Belgium, France, and Finland, were included; no studies were identified from non-Western countries. Most studies had a moderate to high risk of bias. Owing to heterogeneity in outcome definitions and measurements, the results from the 5 RCTs were not meta-analyzed. Three observational studies assessing the place of death were pooled (n = 1136), showing no significant association between ACP and nursing home death [odds ratio (OR), 1.62; 95% CI, 0.72–3.66; I 2 = 69%]. Two studies (n = 453) found that ACP significantly increased documentation of do-not-resuscitate (DNR) directives (OR, 14.12; 95% CI, 3.95–50.47; I 2 = 0%). Certainty of evidence was very low for both nursing home death and DNR documentation. Conclusions and Implications Although ACP programs in nursing homes may increase DNR directives, evidence of other EoL outcomes remains limited and inconsistent. No included studies were conducted in non-Western settings, highlighting the need for culturally sensitive research and standardized outcome reporting in related research.
AB - Objectives To identify the components of advance care planning (ACP) programs implemented in nursing homes, evaluate the range of associated end-of-life (EoL) outcomes for individuals with dementia and their caregivers, and assess their overall effectiveness. Design Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. Setting and Participants Individuals with dementia in nursing homes, their caregivers, and staff members. Methods We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception to December 31, 2024. Studies were eligible if they evaluated ACP interventions delivered in nursing home settings and reported EoL outcomes for individuals with dementia and/or their caregivers. Risk of bias was assessed using the Cochrane ROB 2.0 tool for RCTs and the ROBINS-I tool for observational studies. Certainty of evidence was evaluated using the GRADE framework. Results Ten studies, all conducted in the United States, the United Kingdom, Belgium, France, and Finland, were included; no studies were identified from non-Western countries. Most studies had a moderate to high risk of bias. Owing to heterogeneity in outcome definitions and measurements, the results from the 5 RCTs were not meta-analyzed. Three observational studies assessing the place of death were pooled (n = 1136), showing no significant association between ACP and nursing home death [odds ratio (OR), 1.62; 95% CI, 0.72–3.66; I 2 = 69%]. Two studies (n = 453) found that ACP significantly increased documentation of do-not-resuscitate (DNR) directives (OR, 14.12; 95% CI, 3.95–50.47; I 2 = 0%). Certainty of evidence was very low for both nursing home death and DNR documentation. Conclusions and Implications Although ACP programs in nursing homes may increase DNR directives, evidence of other EoL outcomes remains limited and inconsistent. No included studies were conducted in non-Western settings, highlighting the need for culturally sensitive research and standardized outcome reporting in related research.
UR - https://www.scopus.com/pages/publications/105023477838
UR - https://www.scopus.com/pages/publications/105023477838#tab=citedBy
U2 - 10.1016/j.jamda.2025.105974
DO - 10.1016/j.jamda.2025.105974
M3 - Review article
C2 - 41198038
AN - SCOPUS:105023477838
SN - 1525-8610
VL - 27
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 1
M1 - 105974
ER -