Satisfaction with end-of-life care for nursing home residents with advanced dementia

OBJECTIVES: To identify factors associated with satisfaction with care for healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: Thirteen NHs in Boston. PARTICIPANTS: One hundred forty-eight NH residents aged 65 and older with advanced dementia and their formally designated HCPs. MASUREMENTS: The dependent variable was HCPs' score on the Satisfaction With Care at the End of Life in Dementia (SWC-EOLD) scale (range 10-40; higher scores indicate greater satisfaction). Resident characteristics analyzed as independent variables were demographic information, functional and cognitive status, comfort, tube feeding, and advance care planning. HCP characteristics were demographic information, health status, mood, advance care planning, and communication. Multivariate stepwise linear regression was used to identify factors independently associated with higher SWC-EOLD score. RESULTS: The mean ages +/- standard deviation of the 148 residents and HCPs were 85.0 +/- 8.1 and 59.1 +/- 11.7, respectively. The mean SWC-EOLD score was 31.0 +/- 4.2. After multivariate adjustment, variables independently associated with greater satisfaction were more than 15 minutes discussing advance directives with a care provider at the time of NH admission (parameter estimate = 2.39, 95% confidence interval (CI) = 1.16-3.61, P < .001), greater resident comfort (parameter estimate = 0.10, 95% CI = 0.020.17, P = .01), care in a specialized dementia unit (parameter estimate = 1.48, 95 % CI = 0.25-2.71, P = .02), and no feeding tube (parameter estimate = 2.87, 95% CI = 0.46-5.25, P = .02). CONCLUSION: Better communication, greater resident comfort, no tube feeding, and care in a specialized dementia unit are modifiable factors that may improve satisfaction with care in advanced dementia.