Affiliation:
1. Cicely Saunders Institute King’s College London, , London SE5 9PJ , UK
2. Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de , Santiago , Chile
3. Sussex Community NHS Foundation Trust, Brighton General Hospital , Brighton BN2 3EW , UK
Abstract
AbstractBackgroundemergency department (ED) visits have inherent risks for people with dementia yet increase towards the end-of-life. Although some individual-level determinants of ED visits have been identified, little is known about service-level determinants.Objectiveto examine individual- and service-level factors associated with ED visits by people with dementia in the last year of life.Methodsretrospective cohort study using hospital administrative and mortality data at the individual-level, linked to health and social care service data at the area-level across England. The primary outcome was number of ED visits in the last year of life. Subjects were decedents with dementia recorded on the death certificate, with at least one hospital contact in the last 3 years of life.Resultsof 74,486 decedents (60.5% women; mean age 87.1 years (standard deviation: 7.1)), 82.6% had at least one ED visit in their last year of life. Factors associated with more ED visits included: South Asian ethnicity (incidence rate ratio (IRR) 1.07, 95% confidence interval (CI) 1.02–1.13), chronic respiratory disease as the underlying cause of death (IRR 1.17, 95% CI 1.14–1.20) and urban residence (IRR 1.06, 95% CI 1.04–1.08). Higher socioeconomic position (IRR 0.92, 95% CI 0.90–0.94) and areas with higher numbers of nursing home beds (IRR 0.85, 95% CI 0.78–0.93)—but not residential home beds—were associated with fewer ED visits at the end-of-life.Conclusionsthe value of nursing home care in supporting people dying with dementia to stay in their preferred place of care must be recognised, and investment in nursing home bed capacity prioritised.
Funder
oyal Marsden Partners Pan London Research Fellowship Award
NIHR Clinician Scientist Fellowship
National Institutes of Health
Applied Research Collaboration South London
National Institute for Health and Care Excellence
Royal Marsden Partners
King’s College London
National Institute for Health Research
The Atlantic Philanthropies
Cicely Saunders International
Alzheimer Society
Publisher
Oxford University Press (OUP)
Subject
Geriatrics and Gerontology,Aging,General Medicine
Cited by
2 articles.
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