Critical care admissions for people with dementia are increasing in their last year of life

8 September 2023

Researchers from two London universities have found that while critical care admissions for people with dementia are going down overall, they are increasing during the last year of life.

Ambulance Entry Point at University College Hospital, (credit: Mary Hinkley)

In the first study of its kind, the Empowering Better End of Life Care (EMBED-Care) team at King’s College London and UCL were able to track critical care admissions in South London by linking data from the South London and Maudsley’s Clinical Record Interactive Search with national hospital records.

The researchers found that while the number of people with dementia admitted to critical care units has decreased over the years, there is a small increase in admissions for people with dementia in the final year of life. This study does not compare these trends with critical care admissions data for people without dementia in their last year of life.

Critical care admissions can be lifesaving, but a significant proportion of patients admitted to critical care will die in hospital. The one-year survival of people with dementia following a critical care admission is 48%, which is similar to that observed in general older populations.

Careful consideration of care needs, a multidisciplinary approach and communicating with the patient and their families about preferences and end-of-life wishes are all vital for care planning during critical care admissions.

Previous research from the Cicely Saunders Institute at King’s has shown that eight out of ten 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.

Professor Liz Sampson, Honorary Professor at UCL's Division of Psychiatry and Principal Investigator for the EMBED-Care programme, said: “This study gives us important insights into critical care unit admissions for people with dementia and how these have decreased over time. This suggests that a greater focus on frailty and dementia diagnosis in hospitals has led to more tailored use of critical care interventions for people with dementia.

"However, the rise in critical care admissions over the last year of life for people with dementia should be investigated further; these patients may have benefited from a palliative care approach which takes a more holistic view of their care needs. The UCL and King's College London EMBED-Care research programme will provide answers on how this can be achieved”

Emel Yorganci, lead author and ESRC PhD Training Fellow at King’s College London 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.”

Robert Stewart, Professor of Psychiatric Epidemiology & Clinical Informatics, King’s College London, and Academic Lead for the NIHR Maudsley BRC’s Clinical Record Interactive Search added: “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.”