Katherine E Sleeman1, Gayan Perera2, Robert Stewart3, Irene J Higginson4. 1. Cicely Saunders Institute, Policy and Rehabilitation, King's College London, London, United Kingdom. Electronic address: Katherine.sleeman@kcl.ac.uk. 2. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 3. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom. 4. Cicely Saunders Institute, Policy and Rehabilitation, King's College London, London, United Kingdom.
Abstract
INTRODUCTION: A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear. METHODS: Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013). RESULTS: Of 4867 patients, 78.6% (3824) had at least one ED attendance during their last year of life (mean 2.13, standard deviation 2.34, range 0-54). ED attendance increased over the time period (incidence rate ratio 1.62, 95% confidence interval 1.46-1.80 for 2012-2013 compared with 2008-2009). DISCUSSION: ED attendance in the last year of life for people with dementia is common and is increasing. Policy makers must pay attention to a broader range of indicators of poor end-of-life care alongside the place of death.
INTRODUCTION: A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear. METHODS: Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013). RESULTS: Of 4867 patients, 78.6% (3824) had at least one ED attendance during their last year of life (mean 2.13, standard deviation 2.34, range 0-54). ED attendance increased over the time period (incidence rate ratio 1.62, 95% confidence interval 1.46-1.80 for 2012-2013 compared with 2008-2009). DISCUSSION: ED attendance in the last year of life for people with dementia is common and is increasing. Policy makers must pay attention to a broader range of indicators of poor end-of-life care alongside the place of death.
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