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
| Autor: | Wei Gao, Lesley A. Henson, Catherine J Evans, Buildcare study, Irene J Higginson, Anna E Bone |
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| Rok vydání: | 2018 |
| Předmět: |
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 |
| Zdroj: | 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 |
| ISSN: | 1468-2834 |
| DOI: | 10.1093/ageing/afz043 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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