Saturday, September 30, 2023

Critical care admissions for people with dementia are increasing for those in their last year of life, study finds

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A study led by the Cicely Saunders Institute at King’s College London has found that while critical care admissions for people with dementia are going down, they are increasing during the last year of life.

The study included people with dementia identified from South London and Maudsley NHS Foundation Trust, which covers four South London boroughs (Southwark, Lambeth, Croydon, Lewisham).

The researchers found that while the number of people with dementia admitted to units has decreased over the years, there is a small increase in admissions for people with dementia in the last year of life. This study does not compare these trends with critical care admissions data for people without dementia in their last year of life.

Critical care admissions can be lifesaving, but a significant proportion of patients admitted to critical care will die in hospital. The one-year survival of people with dementia following a critical care admission is 48%, which is similar to that observed in general older populations. Careful consideration of care needs, a multidisciplinary approach and communicating with the patient and their families about preferences and end-of-life wishes are all vital for care planning during critical care admissions.

In the first study of its kind, the Empowering Better End of Life Care (EMBED-Care) team at King’s College London and University College London were able to track critical care admissions of people with dementia in South London by linking data from the South London and Maudsley’s Clinical Record Interactive Search (CRIS) with national hospital records.

“As the number of people living and dying with dementia is increasing, understanding how we can provide high-quality, equitable care to people with dementia until the end of their lives must be a priority. Having access to data can give an insight into care experiences of people with dementia and help to shape and improve the quality of the care they receive. Better quality, nationwide data on the use and quality of dementia health care is an important next step to provide evidence that can inform service planning for people with dementia and improve their care,” said Emel Yorganci, lead author and ESRC Ph.D. Training Fellow at King’s College London.

Robert Stewart, Professor of Psychiatric Epidemiology & Clinical Informatics, King’s College London, and Academic Lead for the NIHR Maudsley BRC’s Clinical Record Interactive Search (CRIS) added, “While recognition of dementia by clinical teams has increased, skills and knowledge to deliver care for those who may be approaching the end of life are often lacking.”

“Quality indicators such as the percentage of people with dementia who had a critical care admission in the last month and year of life, and the documentation of treatment and care preferences may drive improvements in care quality for people with dementia until the end of their lives.”

Previous research from the Cicely Saunders Institute at King’s College London has shown that eight out of ten patients diagnosed with dementia had at least one hospital visit in the last year of their lives, and a quarter of people with visited an emergency visit in the final month before death.

The paper is published in Age and Ageing.

More information:
Emel Yorganci et al, Survival and critical care use among people with dementia in a large English cohort, Age and Ageing (2023).

Critical care admissions for people with dementia are increasing for those in their last year of life, study finds (2023, September 1)
retrieved 1 September 2023

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