title: Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study.
abstract: OBJECTIVE
  To describe patterns in the use of hospital emergency departments in the last year of life by people who died with dementia and whether this was modified by use of community-based palliative care.
  
  
  METHODS
  Retrospective population-based cohort study of people in their last year of life. Time-to-event analyses were performed using cumulative hazard functions and flexible parametric proportional hazards regression models.
  
  
  METHODS
  All people living in Western Australia who died with dementia in the 2-year period 1 January 2009 to 31 December 2010 (dementia cohort; N = 5261). A comparative cohort of decedents without dementia who died from other conditions amenable to palliative care (N = 2685).
  
  
  RESULTS
  More than 70% of both the dementia and comparative cohorts attended hospital emergency departments in the last year of life. Only 6% of the dementia cohort used community-based palliative care compared to 26% of the comparative cohort. Decedents with dementia who were not receiving community-based palliative care attended hospital emergency departments more frequently than people receiving community-based palliative care. The magnitude of the increased rate of emergency department visits varied over the last year of life from 1.4 (95% confidence interval: 1.1-1.9) times more often in the first 3 months of follow-up to 6.7 (95% confidence interval: 4.7-9.6) times more frequently in the weeks immediately preceding death.
  
  
  CONCLUSIONS
  Community-based palliative care of people who die with or of dementia is relatively infrequent but associated with significant reductions in hospital emergency department use in the last year of life.
authors.affiliation: School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia L.Rosenwax@curtin.edu.au.
authors.forename: Lorna
authors.initials: L
authors.lastname: Rosenwax
authors.affiliation: Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
authors.affiliation: Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research and The University of Western Australia, Perth, WA, Australia Department of Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Arendts
authors.affiliation: School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
authors.forename: Bev
authors.initials: B
authors.lastname: McNamara
authors.affiliation: Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Semmens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003704:Dementia / Q000451:nursing*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D014904:Western Australia
keywords: Palliative care; dementia; emergency service; follow-up studies; hospital