Emergency ambulance service involvement with residential care homes in the support of older people with dementia: an observational study

Abstract

BackgroundOlder people resident in care homes have a limited life expectancy and approximately two-thirds have limited mental capacity. Despite initiatives to reduce unplanned hospital admissions for this population, little is known about the involvement of emergency services in supporting residents in these settings.MethodsThis paper reports on a longitudinal study that tracked the involvement of emergency ambulance personnel in the support of older people with dementia, resident in care homes with no on-site nursing providing personal care only. 133 residents with dementia across 6 care homes in the East of England were tracked for a year. The paper examines the frequency and reasons for emergency ambulance call-outs, outcomes and factors associated with emergency ambulance service use.Results56% of residents used ambulance services. Less than half (43%) of all call-outs resulted in an unscheduled admission to hospital. In addition to trauma following a following a fall in the home, results suggest that at least a reasonable proportion of ambulance contacts are for ambulatory care sensitive conditions. An emergency ambulance is not likely to be called for older rather than younger residents or for women more than men. Length of residence does not influence use of emergency ambulance services among older people with dementia. Contact with primary care services and admission route into the care home were both significantly associated with emergency ambulance service use. The odds of using emergency ambulance services for residents admitted from a relative’s home were 90% lower than the odds of using emergency ambulance services for residents admitted from their own home.ConclusionsEmergency service involvement with this vulnerable population merits further examination. Future research on emergency ambulance service use by older people with dementia in care homes, should account for important contextual factors, namely, presence or absence of on-site nursing, GP involvement, and access to residents’ family, alongside resident health characteristics.

Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence

“…Eleven of these 13 studies accounted for need (Amador et al, ; Bardsley et al, ; Blackburn, Locher, & Kilgore, ; Carter, ; Chappell, Dlitt, Hollander, Miller, & McWilliam, ; Deraas, ; Gruneir et al, ; Hollander & Chappell, ; Hutt et al, ; Sloane et al, ; Wysocki et al, ) and a further two did so in a subset of the reported analyses (Reeves & Baker, ; Victor, Healy, Thomas, & Seargeant, ).…”

“…Across included studies, social care utilisation was operationalised as: the amount of social care used (six studies, Table ) (Amador et al, ; Carter, ; Deraas, ; Gruneir et al, ; Hutt et al, ; Reeves & Baker, ); the type of social care used (four studies, Table ) (Bardsley et al, ; Chappell et al, ; Hollander & Chappell, ; Sloane et al, ) and, whether or not social care was used (three studies, Table ) (Blackburn et al, ; Victor et al, ; Wysocki et al, ). The synthesis reports evidence according to these three sub‐groups.…”

“…Of the studies examining the amount of social care, four studies were rated good in quality (Amador et al, ; Gruneir et al, ; Hutt et al, ; Reeves & Baker, ), one was rated fair (Carter, ) and one was rated poor due to irregularities in the analysis presented (Deraas, ). Of studies rated good or fair, outcomes reported were emergency admissions (Reeves & Baker, ), emergency service use (Amador et al, ; Gruneir et al, ) and hospitalisations/inpatient admissions (Carter, ; Hutt et al, ). Two studies were carried out each in the US (Carter, ; Hutt et al, ) and England (Amador et al, ; Reeves & Baker, ) and one in Canada (Gruneir et al, ).…”

“…Of studies rated good or fair, outcomes reported were emergency admissions (Reeves & Baker, ), emergency service use (Amador et al, ; Gruneir et al, ) and hospitalisations/inpatient admissions (Carter, ; Hutt et al, ). Two studies were carried out each in the US (Carter, ; Hutt et al, ) and England (Amador et al, ; Reeves & Baker, ) and one in Canada (Gruneir et al, ). Three studies were specific to a condition group: Alzheimer's, dementia or impairments indicative of dementia (Amador et al, ; Carter, ) and heart failure (Hutt et al, ).…”

Variation in ambulance call rates for care homes in Torbay, UK

“…One previous study investigated ambulance use for residential home residents with dementia and found a large number of calls related to trauma or an ambulatory care sensitive (ACS) condition (Amador et al . ).…”