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

Palliat Med. 2015 Sep;29(8):727-36. doi: 10.1177/0269216315576309. Epub 2015 Mar 17.


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.

Design: 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.

Setting/participants: 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.

Keywords: Palliative care; dementia; emergency service; follow-up studies; hospital.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Community Health Services / organization & administration
  • Community Health Services / statistics & numerical data*
  • Dementia / nursing*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Palliative Care / organization & administration
  • Palliative Care / statistics & numerical data*
  • Regression Analysis
  • Retrospective Studies
  • Western Australia