How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
Voss, Sarah Brandling, Janet Taylor, Hazel Black, Sarah Buswell, Marina Cheston, Richard Cullum, Sarah Prothero, Larissa
Voss, Sarah
Brandling, Janet
Taylor, Hazel
Black, Sarah
Buswell, Marina
Cheston, Richard
Cullum, Sarah
Prothero, Larissa
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Abstract
https://bmjopen.bmj.com/content/8/7/e022549
Objectives An increasing number of older people are
calling ambulances and presenting to accident and
emergency departments. The presence of comorbidities
and dementia can make managing these patients more
challenging and hospital admission more likely, resulting
in poorer outcomes for patients. However, we do not
know how many of these patients are conveyed to
hospital by ambulance. This study aims to determine: how
often ambulances are called to older people; how often
comorbidities including dementia are recorded; the reason
for the call; provisional diagnosis; the amount of time
ambulance clinicians spend on scene; the frequency with
which these patients are transported to hospital.
Methods We conducted a retrospective cross-sectional
study of ambulance patient care records (PCRs) from
calls to patients aged 65 years and over. Data were
collected from two ambulance services in England during
24 or 48 hours periods in January 2017 and July 2017.
The records were examined by two researchers using a
standard template and the data were extracted from 3037
PCRs using a coding structure.
Results Results were reported as percentages and means
with 95% CIs. Dementia was recorded in 421 (13.9%) of
PCRs. Patients with dementia were significantly less likely
to be conveyed to hospital following an emergency call
than those without dementia. The call cycle times were
similar for patients regardless of whether or not they had
dementia. Calls to people with dementia were more likely
to be due to injury following a fall. In the overall sample,
one or more comorbidities were reported on the PCR in
over 80% of cases.
Conclusion Rates of hospital conveyance for older people
may be related to comorbidities, frailty and complex
needs, rather than dementia. Further research is needed to
understand the way in which ambulance clinicians make
conveyance decisions at scene.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074617/pdf/bmjopen-2018-022549.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2018-022549