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Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance: a mortality follow-back survey
- Source :
- 2019, ' Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance : a mortality follow-back survey ', Age and Ageing, vol. 48, no. 5, pp. 676-683 . https://doi.org/10.1093/ageing/afz043
- Publication Year :
- 2018
-
Abstract
- Backgroundfrequent emergency department (ED) attendance at the end of life disrupts care continuity and contradicts most patients’ preference for home-based care.Objectiveto examine factors associated with frequent (≥3) end of life ED attendances among older people to identify opportunities to improve care.Methodspooled data from two mortality follow-back surveys in England. Respondents were family members of people aged ≥65 who died four to ten months previously. We used multivariable modified Poisson regression to examine illness, service and sociodemographic factors associated with ≥3 ED attendances, and directed content analysis to explore free-text responses.Results688 respondents (responses from 42.0%); most were sons/daughters (60.5%). Mean age at death was 85 years. 36.5% had a primary diagnosis of cancer and 16.3% respiratory disease. 80/661 (12.1%) attended ED ≥3 times, accounting for 43% of all end of life attendances. From the multivariable model, respiratory disease (reference cancer) and ≥2 comorbidities (reference 0) were associated with frequent ED attendance (adjusted prevalence ratio 2.12, 95% CI 1.21–3.71 and 1.81, 1.07–3.06). Those with ≥7 community nursing contacts (reference 0 contacts) were more likely to frequently attend ED (2.65, 1.49–4.72), whereas those identifying a key health professional were less likely (0.58, 0.37–0.88). Analysis of free-text found inadequate community support, lack of coordinated care and untimely hospital discharge were key issues.Conclusionsassigning a key health professional to older people at increased risk of frequent end of life ED attendance, e.g. those with respiratory disease and/or multiple comorbidities, may reduce ED attendances by improving care coordination.
- Subjects :
- Male
Aging
Palliative care
03 medical and health sciences
symbols.namesake
0302 clinical medicine
Community support
Medicine
Humans
Terminally Ill
030212 general & internal medicine
Poisson regression
Aged
Frequent attendance
Aged, 80 and over
business.industry
Attendance
Continuity of patient care
General Medicine
Emergency department
Continuity of Patient Care
Patient Acceptance of Health Care
medicine.disease
Comorbidity
Quality Improvement
Hospitals
Hospitalization
Survival Rate
England
030220 oncology & carcinogenesis
symbols
Emergency medicine
Female
Geriatrics and Gerontology
business
Older people
Emergency Service, Hospital
Demography
Subjects
Details
- ISSN :
- 14682834
- Volume :
- 48
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Age and ageing
- Accession number :
- edsair.doi.dedup.....dd0ce410f81fbf580cfc54e5714a2815