Emergency department visits and hospitalisation

An increasing number of older people are using hospital emergency departments (EDs) despite their wish to be treated at home (Marie Curie, 2018). Bone et al (2019a) examined the evidence from 21 published studies comprising over 1 million participants to understand the factors associated with ED attendance in the months preceding death from non-cancer conditions. They found a strong association between lower ED attendance and palliative/hospice care and between higher attendance and non-white ethnicity, male gender, non-cancer diagnoses and rural areas. Interestingly, non-cancer diagnoses attract less palliative care, which suggests that greater access to care and support may reduce ED visits. This review did not include access to generalist nurses or doctors.

Bone et al (2016) explored the factors associated with end-of-life transition from preferred place of care to hospital as place of death among 443 participants over 75 years of age, of whom 146 (32.3%) transferred to hospital and died there in two contrasting geographical areas in southern England. As in the review, non-cancer disease, particularly, respiratory disease and severe breathlessness, was associated with higher hospital admissions with known advance care preferences, and having a key health professional being associated with lower transfer rates. Thus, good district nursing support with appropriate advance care planning may enable people to die at home. McNamara et al's (2018) audit of frequent ED attendance (over four attendances) over 12 months among those aged 65 years and over found that deprivation, dependency, number of long-term conditions and polypharmacy were significant predictors, indicating the importance of social determinants as well as health factors in understanding the use of EDs.