Emergency Department admissions for people with dementia

10th September 2021

Dementia is a progressive degenerative disease with a trajectory that is often difficult to predict. With such uncertainty, provision of optimal end-of-life care remains a clinical, social, and political challenge. People with dementia are likely to experience repeated health crises and subsequent emergency department (ED) attendance toward the end of life. This can be distressing for people with dementia, and has inherent risks including delirium and hospital-acquired complications such as infections, pressure sores, and worsening behavioural symptoms.

However, it is unclear why some people with dementia attend the ED near the end of life and others remain in their usual residence at home or care home. Researchers based at the Cicely Saunders Institute have analysed characteristics that could help identify patients at risk of ED attendance near the end of life and potential service-related factors to reduce risks.

The review found that ethnic minority groups were more likely to attend the ED compared with people of white ethnicity. Higher socioeconomic position was associated with reduced ED attendances. Women were also less likely to attend the ED than men.

There was an increased likelihood of ED attendance when patients had comorbidities, neuropsychiatric symptoms, and a history of previous hospital transfers. People living in more rural or remote areas were more likely to attend the ED than more urban residents.

But people who were unmarried (measured as unpartnered, unmarried, or widowed, separated/divorced, and never married) were less likely to attend, as were people living in residential facilities such as care homes and dementia specialist units. 

Patients receiving palliative care were also less likely to attend emergency departments. Access to skilled community support may help people with dementia stay in their usual place of care toward the end of life.

Williamson LE, Evans CJ, Cripps RL, Leniz J, Yorganci E, Sleeman KE. Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review. JAMDA Journal of Post Acute and Long-Term Care Medicine.

Open Access Published: July 14, 2021

DOI:https://doi.org/10.1016/j.jamda.2021.06.012