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Improving the end-of-life for people with dementia living in a care home: an intervention study

  • Gill Livingston (a1), Elanor Lewis-Holmes (a1), Catherine Pitfield (a1), Monica Manela (a1), Diana Chan (a1), Eleanor Constant (a1), Hannah Jacobs (a2), Gaby Wills (a2), Natasha Carson (a2) and Jackie Morris (a3)...



One in three adults, most of whom are living in a care home at the time, dies with dementia. Their end-of-life is often in hospital, where they may experience uncomfortable interventions without known benefit and die rapidly with uncontrolled pain and comfort needs. This study aimed to improve end-of-life care for people with dementia in a care home by increasing the number and implementation of advanced care wishes.


We recruited staff, residents with dementia, and their relatives from a 120-bed nursing home in London, UK. The intervention was a ten-session manualized, interactive staff training program. We compared advance care wishes documentation and implementation, place of death for residents who died, and themes from staff and family carers’ after-death interviews pre- and post-intervention.


Post-intervention there were significant increases in documented advance care wishes arising from residents’ and relatives’ discussions with staff about end-of-life. These included do not resuscitate orders (16/22, 73% vs. 4/28, 14%; p < 0.001); and dying in the care homes as opposed to hospital (22/29, 76% vs. 14/30, 47%; p < 0.02). Bereaved relatives overall satisfaction increased from 7.5 (SD = 1.3) pre-intervention to 9.1 (SD = 2.4) post-intervention; t = 17.6, p = 0.06. Relatives reported increased consultation and satisfaction about decisions. Staff members were more confident about end-of-life planning and implementing advanced wishes.


This small non-randomized study is the first end-of-life care in dementia intervention to report an increase in family satisfaction with a reduction in hospital deaths. This is promising but requires further evaluation in diverse care homes.


Corresponding author

Correspondence should be addressed to: Professor G. Livingston, Mental Health Sciences Unit, UCL, Charles Bell House, 67-73 Riding House Street 2nd Floor, London W1W 7EJ, UK. Phone: +44 (0)20 7561 4218. Email:


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