• Mirjam C van Soest-Poortvliet, Jenny T van der Steen, Henrica C W de Vet, Cees M P M Hertogh, Bregje D Onwuteaka-Philipsen, and Luc H J Deliens.
• 1 Department of General Practice & Elderly Care Medicine, VU University Medical Center , EMGO Institute for Health and Care Research, Amsterdam, The Netherlands .
• J Palliat Med. 2014 Dec 1; 17 (12): 1317-27.

BackgroundMany people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans.ObjectiveTo describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal.DesignWe used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses.SettingProspective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD).ResultsEight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member.ConclusionsInitially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.

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