Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol
Open accessAbstract
Introduction: Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services. It will also provide evidence of how paramedics make decisions about taking this group of patients to hospital, and what resources would allow them to make more person-focused decisions to enable optimal patient care. Methods and analysis: Phase 1: retrospective data analysis: quantitative analysis of ambulance service data will investigate: how often paramedics are called to older people with dementia; the amount of time paramedics spend on scene and the frequency with which these patients are transported to hospital.Phase 2: observational case studies: detailed case studies will be compiled using qualitative methods, including non-participant observation of paramedic decision-making, to understand why older people with multimorbidities including dementia are conveyed to A&E when they could be treated at home or in the community.Phase 3: needs analysis: nominal groups with paramedics will investigate and prioritise the resources that would allow emergency, urgent and out of hours care to be effectively delivered to these patients at home or in a community setting. Ethics and dissemination: Approval for the study has been obtained from the Health Research Authority (HRA) with National Health Service (NHS) Research Ethics Committee approval for phase 2 (16/NW/0803). The dissemination strategy will include publishing findings in appropriate journals, at conferences and in newsletters. We will pay particular attention to dissemination to the public, dementia organisations and ambulance services.
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Older adults with MLTCiD experience more transitions than those without dementia, and these transitions are more likely to involve fragmented care.
“Older adults with MLTCiD experience more transitions than those without dementia, which are more likely to involve fragmented care [13].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [13]
The Introduction (Background; page not provided) says that, compared with people with the same multimorbidities without dementia, those with dementia have higher risks of ambulance use, A&E attendance and hospital admission. The Introduction (Rationale; page not provided) discusses poor information sharing and service integration, but says these issues have not been studied in this group; it does not establish that their transitions are more likely to involve fragmented care than those of people without dementia. (LLM, conf=0.86)
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- Authors
- Voss, S., Black, S., Brandling, J., Buswell, M., Cheston, R., Cullum, S., Kirby, K., Purdy, S., Solway, C., Taylor, H., & Benger, J.
- Affiliations
- University of the West of England (GB)
- South Western Ambulance Service NHS Foundation Trust (GB)
- University of Hertfordshire (GB)
- University of Auckland (NZ)
- University of Bristol (GB)
- Alzheimer's Society (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- Corresponding author
- Voss, S
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-04
- Volume
- 7
- Issue
- 4
- Pages
- e016651
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5387974
- OpenAlex
- W2605358397
- Cited by
- 35
- References
- 17
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 1 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 1 · 2018: 1 · 2017: 1
- FWCI
- 3.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Explore Bristol Research (acceptedVersion, cc-by)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by-nc)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion, cc-by)
- amber - ambulance research repository (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research (PB-PG-0215-36098)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dementia, multimorbidity, older adults, avoidable hospitalizations, paramedic decision-making, emergency department visits, community-based care, person-centred care
- MeSH terms
- Clinical Decision-Making, Multiple Chronic Conditions, Aged, Aged, 80 and over, Ambulances, Dementia, Emergencies, Emergency Medical Services, Emergency Medical Technicians, Emergency Service, Hospital, England, Female, Hospitalization, Humans, Male, Retrospective Studies, State Medicine, Comorbidity, Qualitative Research
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