Objective Hospital admissions of care home residents close to the end of life are a source of concern and frequently described as ‘inappropriate’ and avoidable. However, the magnitude of this ‘problem’ on a national scale has not been investigated to date. This recently completed study investigated trends and characteristics of emergency admissions from care home to hospital where death occurred within seven days.
Methods Longitudinal and cross-sectional analysis of linked Hospital Episode Statistics with ONS mortality data for England 2006 to 2015: 1 85 830 care home residents aged 25+who experienced a last week of life emergency admission to hospital, with comparator group 9 03 175 care home residents who died in care homes.
Results Of those in the last week of life in a care home 16.1% had an emergency hospital admission; of whom 91.3% died in hospital. Last week of life admissions contributed 14.6% of emergency admissions from care home to hospital and 9.2% of hospital mortality following emergency admission. Residents who had an emergency admission in the last week of life were less likely to be female (OR 0.84, CI: 0.83 to 0.85), from older age groups (OR 0.35, CI: 0.34 to 0.37, for 95+compared with 25–64) or to have dementia (OR 0.37, CI: 0.36 to 0.37). They were more likely to have an underlying cause of death of stroke (OR 2.74, CI: 2.67 to 2.80), heart disease (OR 3.29, CI: 3.21 to 3.36), chronic respiratory disease (OR 3.91, CI: 3.81 to 4.01) acute respiratory disease (OR 5.74, CI: 5.61 to 5.88) or external injury (OR 9.73, CI: 9.32 to 10.16) compared to cancer. Trend analysis revealed significant decreases in these admissions from 2008 onwards
Conclusions Last week of life hospital admissions are a small, and decreasing, risk for care home residents, the majority of whom remain in their care home in the final week of life. The implications for practice and policy are discussed
N.B. Data analysis recently completed: late-breaking abstract
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