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Community support urged to curb ED use by patients with dementia

Researchers have called for better support in the community for people with dementia after a study found that patients are increasingly relying on emergency care as they near death, except for residents of care homes.

Researchers have called for better support in the community for people with dementia after a study found that patients are increasingly relying on emergency care as they near death, except for residents of care homes

dementia
Nearly 80% of dementia patients had at least one ED visit
in their last year of life. Picture: John Houlihan

People with dementia  are increasingly relying on emergency care as they near death, and better support is needed in the community, a study found.

The King's College London researchers examined medical records from a large mental health care provider in south London, covering 4,867 dementia patients who died between 2008-9 and 2012-13 with a mean age of 85.

During their last year of life these patients attended the emergency department (ED) 10,361 times, with 79% of patients having at least one attendance.

The frequency of attendance at EDs increased as participants drew closer to death, with 44% attending at least once during their last month of life.

Quality of life

Attendances were likely to be emergency referrals, by ambulance or out of hours, suggesting they were unplanned and precipitated by an acute crisis, the authors said.

The average number of ED attendances per patient during the last year of life increased from 1.6 visits in 2008-9 to 2.4 in 2012-13.

'For people with dementia, high rates of emergency department attendance near the end of life may indicate inadequate availability of community care, a paucity of advance directives, or lack of focus on patients' quality of life,' the authors wrote.

Being resident in a care home was associated with reduced likelihood of ED attendance, the authors said.


Sleeman K et al (2017) Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. doi.org/10.1016/j.jalz.2017.06.2267. 

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