Critical care admissions for dementia patients increasing in last year of life

The first of its kind research, led by the Cicely Saunders Institute at King’s College London, looked at people with dementia identified at South London and Maudsley NHS Foundation Trust, which covers the boroughs of Southwark, Lambeth, Croydon, Lewisham.

It found that, while the number of people with dementia admitted to critical care units had decreased in recent years, there had been a small increase in admissions for people with dementia in the last year of life.

“Understanding how we can provide high-quality, equitable care to people with dementia until the end of their lives must be a priority”

Emel Yorganci

It follows previous research by the Cicely Saunders Institute, which found that eight out of 10 patients diagnosed with dementia had at least one hospital visit in the last year of their lives, and a quarter of people with dementia visited an emergency visit in the final month before death.

The latest study, published in Age and Ageing last week, has come as the number of people living with dementia continues to rise.

Researchers warned that providing high-quality and equitable care to people with dementia remained “a major challenge”.

Reasons for the up-trend of critical care admissions for people with dementia “may be complex”, they added.

The study noted that, while recognition of dementia by health professionals had increased, the skills and knowledge to deliver care for those with dementia approaching end of life were “often lacking”.

The study said: “Critical care use among people with dementia, and relevant outcomes such as their survival and the concordance of care with their preferences should be monitored to minimise burden, and meet care needs appropriately.”

It added: “To make good judgements about the appropriateness of care and inform service provision at a population-level, access to high-quality and clinically relevant routinely collected data is essential.”

The study concluded that a careful consideration of care needs, multidisciplinary approach and communicating with the patient and their families about preferences and end-of-life wishes were all “vital for care planning during critical care admissions”.

Emel Yorganci, lead author of the study, said: “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 healthcare is an important next step to provide evidence that can inform service planning for people with dementia and improve their care.”

Meanwhile Robert Stewart, professor of psychiatric epidemiology and clinical informatics at King’s College London, said: “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.”