Trends in Critical Care Admissions of People with Dementia in the Last Year of Life in a Large English Cohort Using a Novel Data Linkage (Sampson, 2023)

Yorganci E., Sleeman K.E., Sampson E.L., Stewart R.

Palliative Medicine 2023;37(1 Supplement): 125.

Background/aims: Critical care admissions (CCAs) of people with dementia, need careful consideration as to whether benefits outweigh treatment burdens. CCA rates for people with dementia in the last year of life vary across countries but there is little information on this from England. We investigated trends in CCAs of people with dementia in the last year of life using a novel data linkage in a large English cohort.

Method(s): Retrospective cohort study using mental healthcare data of decedents diagnosed with dementia in South London and Maudsley Hospital, UK (2007-2020), linked with national hospital use data to identify those who had >=1 CCAs. We extracted sociodemographic, illness and admission-related data. Outcomes were number and age-sex standardised rates of CCAs in the last year of life and place of death. We described variables (median (Q1-Q3) & frequencies (%)), examining temporal trends using linear regression.

Result(s): Of 14,469 decedents with dementia, 612 (4.2%) people had >=1 CCA, while 355 (2.5%) had a CCA in the last year of life. Median age at CCA was 81.5 (76-86.5), 50.7% (n=310) women and in 53.2% (n=325) dementia severity was mild. Almost a third (n=175, 28.6%) of the decedents died in the hospital following the CCA, including 46.3% (n=81) who died in the critical care unit after a median of 10 (3-19) days. 30.4% (n=186) were discharged and died in a later hospital admission, and 41.0% (n=251) died elsewhere. Over a 12-year period, despite a decrease in overall CCA use among people with dementia (beta=-0.05; 95%CI -0.01, -0.0003; p=0.04), CCA rates in the last year of life increased from 0.95% (2008) to 2.63% (2019) (beta=0.11, 95% CI 0.01 - 0.20, p=0.03).

Conclusion(s): While only 2.5% of decedents with dementia experienced a CCA in the last year of life, an increase in CCAs in the last year of life was observed over the time period. Detailed, population-level data is required to be able to make better judgements about the nature of CCAs among people with dementia nearing the end of life.