Mitchell SL, et al. – The present study aimed to elucidate and identify factors associated with the level of care preferences among proxies of nursing home residents with advanced dementia. The physicians revealed that the majority of proxies select comfort as the preferred level of care for nursing home residents with advanced dementia. Discussions regarding prognosis were modifiable factors that could promote a preference for comfort care in this population as well as an inquiry about goals of care.

Methods

• From 62 Boston-area facilities as part of an ongoing randomized clinical trial, nursing home residents with advanced dementia and their proxies (N=402 dyads) were recruited.
• The physicians asked all proxies to select which level of care they felt the resident should receive: intensive, basic or comfort care at baseline.
• Multivariable logistic regression identified resident and proxy factors associated with a preference for comfort care (versus basic or intensive medical care).

Results

• In this study, proxy level of care preferences were: comfort, 62.2%; basic, 31.1%; and intensive medical care, 6.5%.
• Proxy perception that the resident had less than 6 months to live was most strongly correlated with a preference for comfort-focused care (adjusted odds ratio (AOR) 12.25, 95% confidence interval (CI) 4.04 - 37.08) in multivariable analyses.
• Additional factors significantly correlated with a preference for comfort care included: older resident age, worse resident cognitive impairment, and the proxy having been asked about goals of care preferences by a nursing home health care provider (AOR 1.71, 95% CI 1.07, 2.74).