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End-of-life care in older people. A study of advance care planning and end-of-life decision-making in Flanders, Belgium

Friday, 14 January, 2011 - 17:00
Campus: Brussels Health Campus
Faculty: Medicine and Pharmacy
auditorium R. Vanden Driessche
Cindy De Gendt
phd defence

With an ageing population, the pattern of disease
and dying is changing. Currently, two thirds of all
deaths in Flanders are non-sudden deaths and
are likely to involve some type of end-of-life care
before death. During the last few decades the
awareness has grown that for these patients
prolonging life at any cost may not always be the
best solution; palliation and improvement of the
quality of life may prevail over futile and often
burdensome treatments.

This dissertation is dedicated to end-of-life care
for the increasing group of older people in our
society, and the preceding decision-making
processes (advance care planning and medical
decision-making at the very end of life). This age
group needs special attention because decisionmaking
at their end of life is often complicated by
loss of competence caused by dementia or other
final stage diseases, and by lower general
condition and comorbidity. The focus is on
medical end-of-life decision-making and terminal
sedation at the very end of life for this age group
in general, and on advance care planning in
institutionalised care for older people. In the
acute setting of geriatric wards, policy and actual
practice concerning do-not-resuscitate decisionmaking
is considered. In the long-term care
setting of nursing homes, policy and actual
practice regarding advance care planning in
general (several end-of-life decisions) is