Emergency admissions from care home to hospital at the end of life: an analysis of national data 2006-2015 for England

06 Jun 2018

Objective To investigate trends and characteristics of emergency admissions from care home to hospital where death occurred within seven days. Design Longitudinal and cross sectional analysis of routine data. Setting Linked Hospital Episode Statistics with ONS mortality data. Participants 185,830 permanent care home residents aged 25+ who experienced a last week of life emergency admission to hospital (61.5% female). Comparator group 903,175 care home deaths (67.1% female). Main outcome measure Last week of life emergency admission from care home to hospital. 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 0.83-0.85), from older age groups (OR 0.35, CI 0.34-0.37, for 95+ compared with 25-64) or to have dementia (OR 0.37, CI 0.36-0.37). They were more likely to have an underlying cause of death of stroke (OR 2.74, CI 2.67-2.80), heart disease (OR 3.29, CI 3.21-3.36), chronic respiratory disease (OR 3.91, CI 3.81-4.01) acute respiratory disease (OR 5.74, CI 5.61-5.88) or external injury (OR 9.73, CI 9.32-10.16) compared to cancer. Conclusion Last week of life admissions are a small, and decreasing, risk for care home residents. There are differences between emergency admissions from care home to hospital in the last week of life and admissions that occur further from death.