Survival and critical care use among people with dementia in a large English cohort

TY - JOUR

T1 - Survival and critical care use among people with dementia in a large English cohort

AU - Yorganci, Emel

AU - Sleeman, Katherine E.

AU - Sampson, Elizabeth L.

AU - Stewart, Robert

AU - The EMBED-Care Programme

N1 - Funding Information: This project is funded by the Economic and Social Research Council (ESRC) and National Institute for Health and Care Research (NIHR) through the ESRC/NIHR Dementia Initiative 2018 (Grant Reference Number ES/S010327/1). R.S. is part-funded by (i) the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; (ii) the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust; (iii) the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386); (iv) the UK Prevention Research Partnership (Violence, Health and Society, MR-VO49879/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations and leading health research charities. K.E.S. is the Laing Galazka Chair in palliative care at King’s College London and is funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation. This project was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR). ESRC is part of the UK Research and Innovation. The views expressed are those of the authors and not necessarily those of the ESRC, UKRI, NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2023 Oxford University Press. All rights reserved.

PY - 2023/9

Y1 - 2023/9

N2 - Background: Admitting people with dementia to critical care units may not always lead to a clear survival benefit. Critical care admissions of people with dementia vary across countries. Little is known about the use and trends of critical care admissions of people with dementia in England. Objective: To investigate critical care use and survival among people with dementia in a large London catchment area. Methods: A retrospective cohort study using data from dementia assessment services in south London, UK (2007–20) linked with national hospitalisation data to ascertain critical care admissions. Outcomes included age–sex-standardised critical care use and 1-year post-critical care admission survival by dementia severity (binary: mild versus moderate/severe). We used logistic regression and Kaplan–Meier survival plots for investigating 1-year survival following a critical care admission and linear regressions for time trends. Results: Of 19,787 people diagnosed with dementia, 726 (3.7%) had ≥1 critical care admission at any time after receiving their dementia diagnosis. The overall 1-year survival of people with dementia, who had a CCA, was 47.5% (n = 345). Dementia severity was not associated with 1-year survival following a critical care admission (mild dementia versus moderate–severe dementia odds of 1-year mortality OR: 0.90, 95% CI [0.66–1.22]). Over the 12-year period from 2008 to 2019, overall critical care use decreased (β = −0.05; 95% CI = −0.01, −0.0003; P = 0.03), while critical care admissions occurring during the last year of life increased (β = 0.11, 95% CI = 0.01, 0.20, P = 0.03). Conclusions: In this cohort, while critical care use among people with dementia declined overall, its use increased among those in their last year of life. Survival remains comparable to that observed in general older populations.

AB - Background: Admitting people with dementia to critical care units may not always lead to a clear survival benefit. Critical care admissions of people with dementia vary across countries. Little is known about the use and trends of critical care admissions of people with dementia in England. Objective: To investigate critical care use and survival among people with dementia in a large London catchment area. Methods: A retrospective cohort study using data from dementia assessment services in south London, UK (2007–20) linked with national hospitalisation data to ascertain critical care admissions. Outcomes included age–sex-standardised critical care use and 1-year post-critical care admission survival by dementia severity (binary: mild versus moderate/severe). We used logistic regression and Kaplan–Meier survival plots for investigating 1-year survival following a critical care admission and linear regressions for time trends. Results: Of 19,787 people diagnosed with dementia, 726 (3.7%) had ≥1 critical care admission at any time after receiving their dementia diagnosis. The overall 1-year survival of people with dementia, who had a CCA, was 47.5% (n = 345). Dementia severity was not associated with 1-year survival following a critical care admission (mild dementia versus moderate–severe dementia odds of 1-year mortality OR: 0.90, 95% CI [0.66–1.22]). Over the 12-year period from 2008 to 2019, overall critical care use decreased (β = −0.05; 95% CI = −0.01, −0.0003; P = 0.03), while critical care admissions occurring during the last year of life increased (β = 0.11, 95% CI = 0.01, 0.20, P = 0.03). Conclusions: In this cohort, while critical care use among people with dementia declined overall, its use increased among those in their last year of life. Survival remains comparable to that observed in general older populations.

KW - critical care

KW - dementia

KW - intensive care

KW - older people

KW - routine data

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85170175018&partnerID=8YFLogxK

U2 - 10.1093/ageing/afad157

DO - 10.1093/ageing/afad157

M3 - Article

C2 - 37678881

AN - SCOPUS:85170175018

SN - 0002-0729

VL - 52

JO - Age and Ageing

JF - Age and Ageing

IS - 9

M1 - afad157

ER -