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

TY - JOUR

T1 - Patterns of emergency department attendance among older people in the last three months of life and factors associated with frequent attendance

T2 - a mortality follow-back survey

AU - BUILDCARE study

AU - Bone, Anna E

AU - Evans, Catherine J

AU - Henson, Lesley A

AU - Gao, Wei

AU - Higginson, Irene J

N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: frequent emergency department (ED) attendance at the end of life disrupts care continuity and contradicts most patients' preference for home-based care.OBJECTIVE: to examine factors associated with frequent (≥3) end of life ED attendances among older people to identify opportunities to improve care.METHODS: pooled 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.RESULTS: 688 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.CONCLUSIONS: assigning 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.

AB - BACKGROUND: frequent emergency department (ED) attendance at the end of life disrupts care continuity and contradicts most patients' preference for home-based care.OBJECTIVE: to examine factors associated with frequent (≥3) end of life ED attendances among older people to identify opportunities to improve care.METHODS: pooled 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.RESULTS: 688 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.CONCLUSIONS: assigning 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.

KW - Aged

KW - Continuity of patient care

KW - Emergency medicine

KW - Hospitals

KW - Palliative care

UR - http://www.scopus.com/inward/record.url?scp=85068253274&partnerID=8YFLogxK

U2 - 10.1093/ageing/afz043

DO - 10.1093/ageing/afz043

M3 - Article

C2 - 31127300

SN - 0002-0729

VL - 48

SP - 676

EP - 683

JO - Age and Ageing

JF - Age and Ageing

IS - 5

ER -