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Palliat Med. 2018 Mar;32(3):613-621. doi: 10.1177/0269216317719588. Epub 2017 Jul 21.

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

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1 Faculty of Medicine, Laval University, Quebec City, QC, Canada.
2 Quebec Centre of Excellence on Aging, Quebec City, QC, Canada.
3 Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
4 Veterans Affairs Canada, Montreal, QC, Canada.
5 Centre on Aging and Health, University of Regina, Regina, SK, Canada.
6 Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.



Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care.


To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities.


Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying.


A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group).


The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group.


Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.


Long-term care; dementia; end-of-life care; palliative care

[Indexed for MEDLINE]

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