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Advance Care Planning (ACP) strengthens patient autonomy and helps align end-of-life care with individual preferences. This prospective observational study evaluated the acceptability and feasibility of a stepwise ACP model in Spanish nursing homes, analyzing clinical characteristics, frailty, functional status, cognition, and nutritional factors. Results showed high acceptance and a gradient of care goals by frailty level.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/advance-care-planning-and-frailty-in-nursing-homes-feasibility-and-acceptance-of-a-stepwise-long-term-care-structured-model/461609/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/advance-care-planning-and-frailty-in-nursing-homes-feasibility-and-acceptance-of-a-stepwise-long-term-care-structured-model/461609.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the purpose of this study regarding advance care planning in nursing homes?","Question",{"text":112,"@type":113},"The study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes, including how residents’ frailty relates to care goals and preferences.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the ACP model structured in the study?",{"text":117,"@type":113},"ACP followed three progressive levels: identifying values and goals, making decisions about specific interventions in acute situations, and establishing end-of-life preferences including preferred place of death and comfort-focused measures.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the results show about acceptance and care preferences?",{"text":121,"@type":113},"Of 79 new residents, 93.7% accepted ACP. Preferences varied by frailty level, showing higher rates for do-not-resuscitate orders and greater avoidance of hospital transfer and instrumentalization in higher frailty groups.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461609,1790795173,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Article  \n# Advance Care Planning and Frailty in Nursing Homes:\n\nFeasibility and Acceptance of a Stepwise, Long-Term Care,Structured Model  \nMiguel Sánchez Ortiz 1,2,*, Mercedes Forcano Garcia 1,3, Rogelio Altisent Trota 1 and Javier Rocafort Gil 1,4,5  \n1 Chair of Professionalism and Clinical Ethics, Aragon Health Research Institute (FEPS H36_ 23D), University ofZaragoza, 50009 Zaragoza, Spain  \n2 Geriatrics Department, General University Hospital of Ciudad Real; 13004 Ciudad Real, Spain  \n3 Geriatrics Department, Hospital Nuestra Señora de Gracia, 50004 Zaragoza, Spain  \n4 Palliative Care Unit, Hospital San Juande Dios, 31006 Pamplona, Spain  \n5 Faculty of Health Sciencies, Francisco de Vitoria University, 28223 Madrid, Spain  \n* Correspondence: saortiz.m9@gmail.com  \nAcademic Editors: IsabelRodríguez-Sánchez, WalterSepulveda-Loyola and AlejandroAlvarez-Bustos  \nReceived: 18 October 2025  \nRevised: 10 December 2025  \nAccepted: 24 December 2025  \nPublished: 27 December 2025  \nCopyright: © 2025 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license .  \n## Abstract\n\nBackground/Objectives: Population aging in Europe presents significant healthcare, eco-nomic, and social challenges, particularly in the care of individuals with chronic diseasesand frailty. Advance Care Planning (ACP) fosters patient autonomy and alignsend-of-life care with individual preferences. This study aimed to evaluate the acceptability andfeasibility of an ACP model in nursing homes. Secondary objectives included exploringclinical characteristics of participants and assessing how frailty is associated with residents’care goals and preferences. Methods: A prospective observational study was conductedamong long-term residentsof a Spanish nursing home in 2023 . ACP was offered to all newpermanent residents, withoutcomes assessed through quarterly follow-ups. Acceptancerates, care preferences, and resident satisfaction were primary measures. Clinical data,frailty, functional status, cognitive assessments, and nutritional status were analyzed. Themodel of ACP is structured into three progressive levels: (1) identification of patients’values, preferences, and global goals of care; (2) decision-making regarding specific clinicalinterventionsin acute situations; and (3) end-of-life care preferences, including preferredplace of death, desired companionship, and comfort-focused measures. Results: From  \n79 new residents admitted, 93.7% accepted ACP. The process required an average of 139 minto complete, distributed over 3–4 sessions. The main documented preferences includeddo-not-resuscitate orders (CPR) (79%), hospital transfer decisions (50%), and other indi-vidualized care choices. When stratified by frailty level, which was categorized as low,moderate, or high—we observed a clear gradient in care preferences. CPR preferenceincreased from 59.3% (Low) to 87.5% (Moderate) and 95.2% (High) . Preference to avoidhospital transfer rose from 22.2% to 50.0% and 85.7%, respectively. Avoidance of instrumen-talization increased from 56.2% to 85.0% and 95.0% . Conclusions: ACP in nursing homesis highly acceptable and feasible, with benefits in aligning care with patient preferencesand enhancing satisfaction.  \nKeywords: advance care planning; nursing homes; older adults; frailty; prospective study  \n## 1. Introduction\n\nPopulation aging in Europe presents considerable healthcare, economic, and socialchallenges, especially in the care of individuals with advanced chronic diseases [1] . The  \nWorld Health Organization (WHO) estimates by 2050, that over 30% of the Europeanpopulation will be over 65 years old, increasing the prevalence of chronic conditions andthe need for complex clinical decision-making in advanced stages of life [2] . Connors et al.suggests that this group of older adults frequently faces unwanted hospitalizationsandinvasive procedures th","cbCaidCnDVTmq6PI","https://ap.wps.com/l/cbCaidCnDVTmq6PI","pdf",846254,12,"English","# Abstract\n# 1. Introduction","[{\"question\":\"What was the purpose of this study regarding advance care planning in nursing homes?\",\"answer\":\"The study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes, including how residents’ frailty relates to care goals and preferences.\"},{\"question\":\"How was the ACP model structured in the study?\",\"answer\":\"ACP followed three progressive levels: identifying values and goals, making decisions about specific interventions in acute situations, and establishing end-of-life preferences including preferred place of death and comfort-focused measures.\"},{\"question\":\"What did the results show about acceptance and care preferences?\",\"answer\":\"Of 79 new residents, 93.7% accepted ACP. Preferences varied by frailty level, showing higher rates for do-not-resuscitate orders and greater avoidance of hospital transfer and instrumentalization in higher frailty groups.\"}]","Advance Care Planning and Frailty in Nursing Homes - Feasibility and Acceptance of a Stepwise, Long-Term Care, Structured Model | PDF",1790761963]