King's College London

Research portal

Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)1691-1700
Number of pages10
JournalPalliative Medicine
Volume35
Issue number9
DOIs
PublishedOct 2021

Bibliographical note

Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: J.L is funded by a Royal Marsden Partners Pan London Research Fellowship Award and the Programa Formacion de Capital Humano Avanzado, Doctorado Becas Chile, 2018 (folio 72190265). DY is supported by Cicely Saunders International. KES is funded by a National Institute of Health Research (NIHR) Clinician Scientist Fellowship (CS-2015-15-005), and is the Laing Galazka Chair in Palliative Care at King’s College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation. IJH is an NIHR Senior Investigator Emeritus. IJH is supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. IJH leads the Palliative and End of Life Care theme of the NIHR ARC South London, and co-leads the national theme in this. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or the funding charities. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: J.L is funded by a Royal Marsden Partners Pan London Research Fellowship Award and the Programa Formacion de Capital Humano Avanzado, Doctorado Becas Chile, 2018 (folio 72190265). DY is supported by Cicely Saunders International. KES is funded by a National Institute of Health Research (NIHR) Clinician Scientist Fellowship (CS-2015-15-005), and is the Laing Galazka Chair in Palliative Care at King?s College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation. IJH is an NIHR Senior Investigator Emeritus. IJH is supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King?s College Hospital NHS Foundation Trust. IJH leads the Palliative and End of Life Care theme of the NIHR ARC South London, and co-leads the national theme in this. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or the funding charities. Publisher Copyright: © The Author(s) 2021.

King's Authors

Abstract

Background: Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions.

Aim: To examine the proportion of people with dementia identified as having palliative care needs in their last year of life, and the association between identification of needs and primary, community and hospital services in the last 90 days.

Design: Retrospective cohort study using Discover, an administrative and clinical dataset from 365 primary care practices in London with deterministic individual-level data linkage to community and hospital records.

Setting/participants: People diagnosed with dementia and registered with a general practitioner in North West London (UK) who died between 2016 and 2019. The primary outcome was multiple non-elective hospital admissions in the last 90 days of life. Secondary outcomes included contacts with primary and community care providers. We examined the association between identification of palliative care needs with outcomes.

Results: Among 5804 decedents with dementia, 1953 (33.6%) were identified as having palliative care needs, including 1141 (19.7%) identified before the last 90 days of life. Identification of palliative care needs before the last 90 days was associated with a lower risk of multiple hospital admissions (Relative Risk 0.70, 95% CI 0.58-0.85) and more contacts with the primary care practice, community nurses and palliative care teams in the last 90 days.

Conclusions: Further investigation of the mechanisms underlying the association between identification of palliative care needs and reduced hospital admissions could help reduce reliance on acute care for this population.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454