Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review
Open accessAbstract
OBJECTIVES: Emergency department (ED) attendance is common among people with dementia and increases toward the end of life. The aim was to systematically review factors associated with ED attendance among people with dementia approaching the end of life. DESIGN: Systematic search of 6 databases (MEDLINE, EMBASE, ASSIA, CINAHL, PsycINFO, and Web of Science) and gray literature. Quantitative studies of any design were eligible. Newcastle-Ottawa Scales and Cochrane risk-of-bias tools assessed study quality. Extracted data were reported narratively, using a theoretical model. Factors were synthesized based on strength of evidence using vote counting (PROSPERO registration: CRD42020193271). SETTING AND PARTICIPANTS: Adults with dementia of any subtype and severity, in the last year of life, or in receipt of services indicative of nearness to end of life. MEASUREMENTS: The primary outcome was ED attendance, defined as attending a medical facility that provides 24-hour access to emergency care, with full resuscitation resources. RESULTS: After de-duplication, 18,204 titles and abstracts were screened, 367 were selected for full-text review and 23 studies were included. There was high-strength evidence that ethnic minority groups, increasing number of comorbidities, neuropsychiatric symptoms, previous hospital transfers, and rural living were positively associated with ED attendance, whereas higher socioeconomic position, being unmarried, and living in a care home were negatively associated with ED attendance. There was moderate-strength evidence that being a woman and receiving palliative care were negatively associated with ED attendance. There was only low-strength evidence for factors associated with repeat ED attendance. CONCLUSIONS AND IMPLICATIONS: The review highlights characteristics that could help identify patients at risk of ED attendance near the end of life and potential service-related factors to reduce risks. Better understanding of the mechanisms by which residential facilities and palliative care are associated with reduced ED attendance is needed.
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Existing research found higher emergency department visit rates among people living with dementia with higher comorbidity burden.
“Existing research on associations between individual characteristics of people living with dementia and general use of the ED have found higher visit rates among those with individuals with more severe neuropsychiatric symptoms, higher comorbidity burden, and those living in rural locations.18,19”
From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [18]
Existing research found higher emergency department visit rates among people living with dementia living in rural locations.
“Existing research on associations between individual characteristics of people living with dementia and general use of the ED have found higher visit rates among those with individuals with more severe neuropsychiatric symptoms, higher comorbidity burden, and those living in rural locations.18,19”
From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [18]
Existing research found higher emergency department visit rates among people living with dementia with more severe neuropsychiatric symptoms.
“Existing research on associations between individual characteristics of people living with dementia and general use of the ED have found higher visit rates among those with individuals with more severe neuropsychiatric symptoms, higher comorbidity burden, and those living in rural locations.18,19”
From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [18]
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References 79 · Cited by 38
Research works printed but not linked: 1
- [11]11. [Wiener JM, Feng Z, Coots LA, et al. What is the effect of dementia on hospitalization and emergency department use in residential care facilities? Bethesda, MD: Of fi ce of the Assistant Secretary for Planning and evaluation, US Department of Health and Human Services; 2014.](http://refhub.elsevier.com/S1525-8610(21)00570-3/sref86)
- Authors
- Williamson, L. E., Evans, C. J., Cripps, R. L., Leniz, J., Yorganci, E., & Sleeman, K. E.
- Affiliations
- King's College London (GB)
- Corresponding author
- Williamson, Lesley E.
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 22
- Issue
- 10
- Pages
- 2046-2055.e35
- ISSN
- 1525-8610 (ISSN-L)
- OpenAlex
- W3179821886
- Cited by
- 38
- References
- 79
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 7 · 2023: 9 · 2022: 5
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American Medical Directors Association (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- Alzheimer's Society
- National Institute for Health and Care Research (CL-2010-17-009, CS-2015-15-005, ICA-SCL-2015-01-001)
- Department of Health and Social Care
- Academy of Medical Sciences (AMS‐SGCL10‐Sleeman)
- King's College London
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- dementia, emergency department visits, end of life, risk factors, ethnic minorities, comorbidities, neuropsychiatric symptoms, hospital transfer, rural life, socioeconomic position, marital status, care homes, palliative care, repeat emergency visits, older adults
- MeSH terms
- Adult, Death, Dementia, Emergency Service, Hospital, Ethnicity, Female, Humans, Minority Groups
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