Most ADs failed to state what should be done in case the patient acutely became incapable of consenting to treatment (inter-rater agreement >83%). 52% of the 119 ADs that we analyzed contained no documentation of the patient's decision-making capacity and/or voluntariness, and only 3% contained documentation of a medical consultation. 11% of the nursing home residents had a personal AD, and a further 1.4% an AD by proxy. The specifications of the ADs were compared with what the nurses reported that they would do in each scenario. The ADs were formally analyzed and assessed by 3 raters with respect to 5 clinical decision-making scenarios. In 2007, we carried out a cross-sectional survey in all 11 nursing homes of a German city in the state of North Rhine-Westphalia (total nursing home population, 1089 residents). Little is known, however, about their prevalence in nursing homes, their quality, and whether they are honored. The German Advance Directives Act of 2009 confirms that advance directives (ADs) are binding. Sommer, Sarah Marckmann, Georg Pentzek, Michael Wegscheider, Karl Abholz, Heinz-Harald in der Schmitten, Jürgen Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.Īdvance directives in nursing homes: prevalence, validity, significance, and nursing staff adherence. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities there was no association with characteristics of the nursing home resident. Advance directives were uncommon for nursing home residents with dementia. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider nursing homes had policies for advance directives and a religious affiliation. Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. Nursing home characteristics were obtained from each chief administrator. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan. However, in Taiwan, little is known about what influences the completion of these advance directives. Huang, Hsiu-Li Shyu, Yea-Ing Lotus Weng, Li-Chueh Chen, Kang-Hua Hsu, Wen-ChuinĪBSTRACTBackground: Advance directives are important for nursing home residents with dementia for those with advanced dementia, surrogates determine medical decisions. Predictors of advance directives among nursing home residents with dementia.