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'Worry' at reliance on emergency care for patients with dementia nearing the end of life

There has been a 'worrying' increase in the reliance on emergency care for patients with dementia nearing the end of their lives, experts have warned.

There has been a 'worrying' increase in the reliance on emergency care for patients with dementia nearing the end of their lives, experts have warned.

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

They warned that emergency department (ED) visits can be distressing for patients and are considered preventable in a high number of cases.

And ED use towards the end of life may indicate inadequate availability of community care, according to the authors of a new study published in the journal Alzheimer's & Dementia.

Experts from King's College London conducted a retrospective study examining electronic medical records from a large mental health care provider in south

There has been a 'worrying' increase in the reliance on emergency care for patients with dementia nearing the end of their lives, experts have warned.

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


Researchers find 'worrying reliance on emergency care for end of life'
Picture: iStock

They warned that emergency department (ED) visits can be distressing for patients and are considered preventable in a high number of cases.

And ED use towards the end of life may indicate inadequate availability of community care, according to the authors of a new study published in the journal Alzheimer's & Dementia.

Experts from King's College London conducted a retrospective study examining electronic medical records from a large mental health care provider in south London.

Data analysis

They examined data on 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 ED 10,361 times – with 79% of patients having at least one attendance.

Researchers found that the frequency of attendance at EDs increased as participants drew closer to death, with 44% of the participants having at least one attendance during their last month of life.

These attendances were more likely to be emergency referrals, by ambulance or out of hours, which suggests these visits were 'unplanned and precipitated by an acute crisis,' the authors added.

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

Lead author Katherine Sleeman said: 'Our results show a worrying increase in the reliance on emergency care. In light of the current pressures on the health service, our ageing population and the associated increase in deaths from dementia, there is an urgent need to look at ways we can provide better support for care in the community.'

Default place

Commenting on the study, Simon Jones, director of policy and public affairs at the charity Marie Curie, said the research adds to the growing evidence that health and social care services are not receiving enough support to ensure people receive the care they need.

'Hospital can be the worst possible environment for someone suffering from the confusion associated with dementia and it should not be considered the default place for people to be cared for in their final days,' he added.

A Department of Health spokesperson said: 'Our Dementia 2020 challenge will ensure that everyone can be supported to be as independent as possible and get the care and support they need, wherever they live.

'Some 61% of people are cared for in their own home and since 2010 there has been a growth in home care agencies of more than 2,900.

'We've given local authorities in England an extra £2 billion boost over the next three years to maintain access for our growing ageing population.'

Further information

Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data


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