Research Research Category Acceptability of an Advance Directive That Limits Food and Liquids in Advanced Dementia Presenting Author: Ladislav Volicer, MD, PhD, University of South Florida Author(s): Ladislav Volicer, MD, PhD Introduction/Objective: Some individuals fear living with advanced dementia and may even commit suicide if they receive dementia diagnosis. Living with advanced dementia could be prevented if a person who cannot feed himself or herself would not be fed by others. The purpose of the study was to find out how acceptable would be an advance directive that includes discontinuation of feeding at certain stage of dementia for relatives of persons who died with dementia. Design/Methodology: Relatives of patients with dementia who died between 6 and 12 months ago in a hospice were contacted by phone and asked whether they would be interested in participating in a research study investigating a new approach to advance directives. Fifteen of them actually attended 1 of the 2 focus groups: 12 spouses (4 husbands and 8 wives), 2 daughters, and 1 son-in-law. Nine scenarios of condi- tions encountered in advanced dementia were presented and the par- ticipants were asked for each of them if they would rather die of dehydration caused by not receiving help with eating and drinking than to live in that condition. Responses of focus group participants were recorded, transcribed and analyzed. The study was approved by the IRB at University of South Florida. Results: For each presented condition, the majority of focus group participants indicated that they would be willing to make advance di- rectives which would direct their care providers not to feed them and help them to drink if they were in that condition. Conditions for which almost all participants would specify in advance directives as reasons for stopping food and liquids included severe pain, inability to recognize family or best friends, inability to communicate, and being force-fed. Some of the participants would be willing to make a proxy decision to stop feeding in the absence of advance directives. No participants re- ported that these advance directives would be conflicting with their religious believes. All participants decided that if the person with de- mentia indicates that she/he wants to be fed, that should be considered revocation of the advanced directives and this person should receive help with eating and drinking. Conclusion/Discussion: Advance directives that would stop help with feeding and drinking at a certain stage of dementia progression are acceptable to people who experienced a family member dying with dementia. Availability of these directives may decrease fear of living with advanced dementia in persons with this diagnosis and prevent premature suicides. It remains to be established whether these advance directives would be acceptable to general population and whether health care providers would honor them. Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract. An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care (HELP-LTC) Presenting Author: Kenneth Boockvar, MD, MS, Jewish Home Lifecare Author(s): Kenneth Boockvar, MD, MS, Jeanne Teresi, EdD, PhD; and Sharon Inouye, MD, MPH Introduction/Objective: Nursing home (NH) residents experience 2-4 acute medical conditions each year and have an incidence of delirium during these conditions that is similar to that of hospitalized older adults. Research on the prevention or treatment of delirium in the NH remains limited. The objective of this study was to determine the feasibility of an intervention to reduce delirium and improve outcomes of acute illness in long-term nursing home residents. Design/Methodology: We chose the Hospital Elder Life Program (HELP) as a model for our intervention because adaptations to HELP can be made across multiple domains, including enrollment criteria, screening and assessment tools, and intervention protocols, while remaining effective. We selected intervention components that had evidence to support their use in ameliorating delirium risk factors that are prevalent in nursing home residents, including cognitive impairment, immobility, dehydration, malnutrition, and sleep problems. Risk factor-reducing activities were delivered by expertly trained certified nursing assistants (CNAs), who visited residents throughout a large, urban, non-profit NH facility during treatment for and recovery from acute illness not severe enough to be hospitalized (e.g., urinary or other infection). We collected data on resident demographic and clinical characteristics, characteristics of the acute illness, delirium occurrence, hospital use, mortality, and acceptance of the intervention by nursing home staff. Results: HELP-LTC was delivered to 143 long-term care nursing home residents during 231 acute illness episodes, at an average of 12.8 episodes per month. Sixty-five percent of recipients were female, with an average age of 82 years. The most common illnesses precipitating referral were in- fections of bladder (33%), skin (20%), and lower respiratory tract (15%). CNAs delivered 15.9 daily visits per illness episode with average visit duration of 32.3 minutes. Delirium occurred during 18.0% of acute illnesses, and its severity declined over the course of the acute illness. Among HELP-LTC recipients,13.2% were transferred to the hospital and 11.3% died during the acute illness or within 3 months after discharge from the program. For an exploratory comparison, among 48 non-intervention residents, 23.9% were transferred to the hospital and 15.4% died during the acute illness or within 3 months after discharge from the program. Unit nursing staff indicated that communication between with HELP-LTC staff was effective and endorsed that work stress was lower with the intervention. Conclusion/Discussion: HELP-LTC is feasible and consistent with CMS initiatives to develop and implement improvements in nursing homes. Findings support a test of the intervention in a controlled trial. The intervention would be broadly adoptable if the cost of the program’s CNAs were offset by prevention of hospitalization. JAMDA journal homepage: www.jamda.com 1525-8610/Ó 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA 17 (2016) B23eB29