{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:31:55Z","timestamp":1791045115791,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Feminization of Health Professions Research Group","award":["FEPS, H36_23D"],"award-info":[{"award-number":["FEPS, H36_23D"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Population aging in Europe presents significant healthcare, economic, and social challenges, particularly in the care of individuals with chronic diseases and frailty. Advance Care Planning (ACP) fosters patient autonomy and aligns end-of-life care with individual preferences. This study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes. Secondary objectives included exploring clinical characteristics of participants and assessing how frailty is associated with residents\u2019 care goals and preferences. Methods: A prospective observational study was conducted among long-term residents of a Spanish nursing home in 2023. ACP was offered to all new permanent residents, with outcomes assessed through quarterly follow-ups. Acceptance rates, care preferences, and resident satisfaction were primary measures. Clinical data, frailty, functional status, cognitive assessments, and nutritional status were analyzed. The model of ACP is structured into three progressive levels: (1) identification of patients\u2019 values, preferences, and global goals of care; (2) decision-making regarding specific clinical interventions in acute situations; and (3) end-of-life care preferences, including preferred place of death, desired companionship, and comfort-focused measures. Results: From 79 new residents admitted, 93.7% accepted ACP. The process required an average of 139 min to complete, distributed over 3\u20134 sessions. The main documented preferences included do-not-resuscitate orders (CPR) (79%), hospital transfer decisions (50%), and other individualized care choices. When stratified by frailty level, which was categorized as low, moderate, or high\u2014we observed a clear gradient in care preferences. CPR preference increased from 59.3% (Low) to 87.5% (Moderate) and 95.2% (High). Preference to avoid hospital transfer rose from 22.2% to 50.0% and 85.7%, respectively. Avoidance of instrumentalization increased from 56.2% to 85.0% and 95.0%. Conclusions: ACP in nursing homes is highly acceptable and feasible, with benefits in aligning care with patient preferences and enhancing satisfaction.<\/jats:p>","DOI":"10.3390\/jcm15010214","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:50:42Z","timestamp":1766969442000},"page":"214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Advance Care Planning and Frailty in Nursing Homes: Feasibility and Acceptance of a Stepwise, Long-Term Care, Structured Model"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6713-1983","authenticated-orcid":false,"given":"Miguel","family":"S\u00e1nchez Ortiz","sequence":"first","affiliation":[{"name":"Chair of Professionalism and Clinical Ethics, Aragon Health Research Institute (FEPS H36_23D), University of Zaragoza, 50009 Zaragoza, Spain"},{"name":"Geriatrics Department, General University Hospital of Ciudad Real; 13004 Ciudad Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Forcano Garcia","sequence":"additional","affiliation":[{"name":"Chair of Professionalism and Clinical Ethics, Aragon Health Research Institute (FEPS H36_23D), University of Zaragoza, 50009 Zaragoza, Spain"},{"name":"Geriatrics Department, Hospital Nuestra Se\u00f1ora de Gracia, 50004 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogelio","family":"Altisent Trota","sequence":"additional","affiliation":[{"name":"Chair of Professionalism and Clinical Ethics, Aragon Health Research Institute (FEPS H36_23D), University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Rocafort Gil","sequence":"additional","affiliation":[{"name":"Chair of Professionalism and Clinical Ethics, Aragon Health Research Institute (FEPS H36_23D), University of Zaragoza, 50009 Zaragoza, Spain"},{"name":"Palliative Care Unit, Hospital San Juan de Dios, 31006 Pamplona, Spain"},{"name":"Faculty of Health Sciencies, Francisco de Vitoria University, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). 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