Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study

Javiera Leniz; Irene J Higginson; Robert Stewart; Katherine E Sleeman

doi:10.1093/ageing/afz052

Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study

King's College London, Faulty of Nursing, Midwifery and Palliative care, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK.
Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS foundation trust, London, UK.

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

Abstract

BACKGROUND: transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable.

OBJECTIVE: to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia.

DESIGN: retrospective cohort study.

SETTING: electronic records from a mental health provider in London, linked to national mortality and hospital data.

SUBJECTS: people with dementia who died in 2007-2016.

METHODS: end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression.

RESULTS: of 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11-1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49-0.97), physical illness (OR 1.52, 95% CI 1.20-1.94), depressed mood (OR 1.49, 95% CI 1.17-1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37-0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001).

CONCLUSIONS: in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.

Original language	English
Pages (from-to)	669-676
Number of pages	8
Journal	Age and Ageing
Volume	48
Issue number	5
Early online date	28 May 2019
DOIs	https://doi.org/10.1093/ageing/afz052
Publication status	Published - 1 Sept 2019

Keywords

Dementia
Electronic medical records
Emergency hospital admissions
End-of-life
Transitions

Access to Document

10.1093/ageing/afz052

Cite this

@article{68f2a8fffe644e478d3758745e03fe96,

title = "Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study",

abstract = "BACKGROUND: transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable.OBJECTIVE: to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia.DESIGN: retrospective cohort study.SETTING: electronic records from a mental health provider in London, linked to national mortality and hospital data.SUBJECTS: people with dementia who died in 2007-2016.METHODS: end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression.RESULTS: of 8,880 people, 1,421 (16.0\%) had at least one end-of-life transition: 505 (5.7\%) had early, 788 (8.9\%) late, and 128 (1.5\%) both types. Early transitions were associated with male gender (OR 1.33, 95\% CI 1.11-1.59), age (>90 vs <75 years OR 0.69, 95\% CI 0.49-0.97), physical illness (OR 1.52, 95\% CI 1.20-1.94), depressed mood (OR 1.49, 95\% CI 1.17-1.90), and deprivation (most vs least affluent quintile OR 0.58, 95\% CI 0.37-0.90). Care home residence was associated with fewer early (OR 0.63, 95\% CI 0.53 to 0.76) and late (OR 0.80, 95\% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001).CONCLUSIONS: in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.",

keywords = "Dementia, Electronic medical records, Emergency hospital admissions, End-of-life, Transitions",

author = "Javiera Leniz and Higginson, \{Irene J\} and Robert Stewart and Sleeman, \{Katherine E\}",

note = "{\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.",

year = "2019",

month = sep,

day = "1",

doi = "10.1093/ageing/afz052",

language = "English",

volume = "48",

pages = "669--676",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life

T2 - a retrospective cohort study

AU - Leniz, Javiera

AU - Higginson, Irene J

AU - Stewart, Robert

AU - Sleeman, Katherine E

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: transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable.OBJECTIVE: to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia.DESIGN: retrospective cohort study.SETTING: electronic records from a mental health provider in London, linked to national mortality and hospital data.SUBJECTS: people with dementia who died in 2007-2016.METHODS: end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression.RESULTS: of 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11-1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49-0.97), physical illness (OR 1.52, 95% CI 1.20-1.94), depressed mood (OR 1.49, 95% CI 1.17-1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37-0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001).CONCLUSIONS: in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.

AB - BACKGROUND: transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable.OBJECTIVE: to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia.DESIGN: retrospective cohort study.SETTING: electronic records from a mental health provider in London, linked to national mortality and hospital data.SUBJECTS: people with dementia who died in 2007-2016.METHODS: end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression.RESULTS: of 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11-1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49-0.97), physical illness (OR 1.52, 95% CI 1.20-1.94), depressed mood (OR 1.49, 95% CI 1.17-1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37-0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001).CONCLUSIONS: in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.

KW - Dementia

KW - Electronic medical records

KW - Emergency hospital admissions

KW - End-of-life

KW - Transitions

UR - https://www.scopus.com/pages/publications/85072517757

U2 - 10.1093/ageing/afz052

DO - 10.1093/ageing/afz052

M3 - Article

C2 - 31135024

SN - 0002-0729

VL - 48

SP - 669

EP - 676

JO - Age and Ageing

JF - Age and Ageing

IS - 5

ER -

Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this