Cargando…

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

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. Ho...

Descripción completa

Detalles Bibliográficos
Autores principales: Voss, Sarah, Brandling, Janet, Taylor, Hazel, Black, Sarah, Buswell, Marina, Cheston, Richard, Cullum, Sarah, Foster, Theresa, Kirby, Kim, Prothero, Larissa, Purdy, Sarah, Solway, Chris, Benger, Jonathan Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074617/
https://www.ncbi.nlm.nih.gov/pubmed/30068624
http://dx.doi.org/10.1136/bmjopen-2018-022549
_version_ 1783344451849027584
author Voss, Sarah
Brandling, Janet
Taylor, Hazel
Black, Sarah
Buswell, Marina
Cheston, Richard
Cullum, Sarah
Foster, Theresa
Kirby, Kim
Prothero, Larissa
Purdy, Sarah
Solway, Chris
Benger, Jonathan Richard
author_facet Voss, Sarah
Brandling, Janet
Taylor, Hazel
Black, Sarah
Buswell, Marina
Cheston, Richard
Cullum, Sarah
Foster, Theresa
Kirby, Kim
Prothero, Larissa
Purdy, Sarah
Solway, Chris
Benger, Jonathan Richard
author_sort Voss, Sarah
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6074617
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-60746172018-08-09 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 Foster, Theresa Kirby, Kim Prothero, Larissa Purdy, Sarah Solway, Chris Benger, Jonathan Richard BMJ Open Emergency Medicine 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. BMJ Publishing Group 2018-08-01 /pmc/articles/PMC6074617/ /pubmed/30068624 http://dx.doi.org/10.1136/bmjopen-2018-022549 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Emergency Medicine
Voss, Sarah
Brandling, Janet
Taylor, Hazel
Black, Sarah
Buswell, Marina
Cheston, Richard
Cullum, Sarah
Foster, Theresa
Kirby, Kim
Prothero, Larissa
Purdy, Sarah
Solway, Chris
Benger, Jonathan Richard
How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title_full How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title_fullStr How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title_full_unstemmed How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title_short How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project
title_sort how do people with dementia use the ambulance service? a retrospective study in england: the homeward project
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074617/
https://www.ncbi.nlm.nih.gov/pubmed/30068624
http://dx.doi.org/10.1136/bmjopen-2018-022549
work_keys_str_mv AT vosssarah howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT brandlingjanet howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT taylorhazel howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT blacksarah howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT buswellmarina howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT chestonrichard howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT cullumsarah howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT fostertheresa howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT kirbykim howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT protherolarissa howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT purdysarah howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT solwaychris howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject
AT bengerjonathanrichard howdopeoplewithdementiausetheambulanceservicearetrospectivestudyinenglandthehomewardproject