Accident and emergency attendance among patients with dementia in the last year of life is both “common” and has increased over time, warn UK researchers.
They found more than three quarters of dementia patients had at least one A&E attendance in their last year of life.
“Our data show that emergency department attendance in the last year of life follows the opposite trend”
The researchers, from King’s College London and South London and Maudsley National Health Service NHS Foundation Trust, looked at hospital attendance and mortality data from 2008-13.
Of 4,867 South London dementia patients who died, 3,824 had at least one A&E attendance during their last year of life – equivalent to 78.6%.
In total, the patients in the study cohort attended the A&E at the South London and Maudsley 10,361 times.
A&E attendance also increased over the time period studied, highlighted the researchers. The mean number per patient during the last year of life was 2.1, rising from 1.6 for 2008-09 to 2.4 in 2012-13.
However, being resident in a care home was found to “mitigate against” A&E attendance, sparking the researchers to call for more capacity in this sector for patients with dementia.
“Given the projected increase in prevalence of dementia, our data suggest that investment in care home capacity is urgently needed to mitigate against rising emergency department attendance near to the end-of-life,” said the study authors.
“People with complex and deteriorating needs are sometimes regarded simply as a set of care needs”
Meanwhile, of those who had at least one attendance in the last year of life, 44.5% were found to have had at least one in their last month of life and 20.9% at least one during their last week of life.
Referral of patients to the A&E was via the emergency services in 35.1% of attendances, via self in 17.6%, via the GP in 5.6%, and other in 41.8%, said the researchers.
In addition, they found 72.7% of attendances resulted in hospital admission, 15.8% resulted in discharge and 4.9% in discharge with GP follow-up.
The authors said: “Although the proportion of people with dementia dying in hospitals has fallen, our data show that emergency department attendance in the last year of life follows the opposite trend.
“We recommend that policy makers consider a broader range of indicators of the quality of end-of-life care alongside the place of death,” they added in the journal Alzheimer’s and Dementia.
Julia Scott, chief executive of the Royal College of Occupational Therapists, said: “Sadly, people with complex and deteriorating needs are sometimes regarded simply as a set of care needs rather than as a person who need increasing help and support.
“This can lead to the type of disjointed care highlighted in this report and results in thousands of unnecessary hospital admissions every year, at huge financial cost to the health and care system and emotional cost to the person and their family,” she said.
“This is especially true for people who have dementia,” she said. “The sudden transfer into an unfamiliar environment, with unfamiliar faces and invasive procedures causes unnecessary distress.”