Dementia A&E attendance increasing
A study from King’s College London and the National Institute of Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) has found that Accident and Emergency (A&E) attendance among people with dementia in their last year of life is common and increasing.
In the study, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the researchers identified people who had dementia and who had died over a five year period (2008 - 2013).
The team used the NIHR Maudsley BRC Clinical Record Interactive Search (CRIS) database linked to Hospital Episodes Statistics from NHS Digital to provide information on A&E use among people with dementia in their last year of life.
For people who are approaching the end of life, attending A&E can be distressing. It is also often unnecessary and can be prevented. Sometimes people with dementia do need to be admitted to hospital, but admissions can also lead to deterioration, with an increased risk of infections, bedsores and distress.
The paper’s main findings include:
- Out of 4,867 people with dementia who had died, 78.6% had at least one A&E attendance during their last year of life
- A&E attendance became more common the closer people were to death, with 44.5% having an A&E attendance in their last month of life, and a fifth of people with dementia attending A&E in their last week of life
- People living in a care home had fewer A&E attendances, which may be because plans were put in place to avoid this
- The likelihood of attending A&E increased over time: people who died in the most recent year studied were 1.6 times more likely to attend A&E then in the previous years.
Lead author Dr Katherine Sleeman, from the Cicely Saunders Institute at King’s College London and Clinical Scientist at the NIHR Maudsley BRC, said:
Recognition of the need to improve end of life care for people with dementia has been increasing. This includes enabling them to be cared for in their own home or in a care home. However, 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.
Guy’s and St Thomas’ NHS Foundation Trust created Barbara’s Story, an award- winning set of short films to help staff recognise and support people with dementia. View this on the King’s Health Partners Learning Hub.
The King’s Health Partners Mental Health of Older Adults and Dementia Clinical Academic Group has world leading researchers in dementia and older people’s psychosis, mood, anxiety and personality disorders.