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    How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project

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    Author
    Voss, Sarah
    Brandling, Janet
    Taylor, Hazel
    Black, Sarah
    Buswell, Marina
    Cheston, Richard
    Cullum, Sarah
    Foster, Theresa cc
    Kirby, Kim cc
    Prothero, Larissa
    Purdy, Sarah
    Solway, Chris
    Benger, Jonathan cc
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    Keyword
    Emergency Medical Services
    Admission Avoidance
    Dementia
    Geriatric Medicine
    Pre-hospital Care
    Journal title
    BMJ Open
    
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    URI
    http://hdl.handle.net/20.500.12417/79
    DOI
    10.1136/bmjopen-2018-022549
    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
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2018-022549
    Scopus Count
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    Publications - East of England Ambulance Service
    Publications - South Western Ambulance Service

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