Carer and clinician perceptions of the use of emergency medical services by people with dementia: a qualitative study.

Sarah Voss,Janet Brandling,Sarah Cullum,Sarah Black,Steve Iliffe,Sarah Purdy,Jonathan Benger,Rik Cheston

doi:10.1017/s1463423618000191

Abstract

A growing number of older people are accessing emergency medical services (EMS), and many calls to EMS are made by, or on behalf of, people with dementia. Their needs are frequently complex; however, EMS staff are often given minimal guidance on ensuring patient safety, accurate diagnosis, and timely transfer to the most appropriate care. This study aimed to qualitatively explore the EMS experiences of carers for people with dementia and assess the views of EMS staff on the management of dementia, using focus groups and interviews. Themes were focussed on the circumstances surrounding EMS calls to people with dementia. These can prove frustrating due to a lack of information sharing, limited alternatives to hospital attendance and the amount of time that it can take to meet the complex needs of a person with dementia.

Highlights

Whilst the majority of urgent care is delivered in primary care settings, an increasing number of older people are accessing emergency medical services (EMS) and emergency departments (EDs) (The Silver Book, 2012)
Just over 20% of older adults calling an emergency ambulance have dementia or cognitive impairment documented in their pre-hospital records (Buswell et al, 2016); and it is likely that there is an additional group of patients with undiagnosed dementia
This was a qualitative study with EMS staff and carers of people with dementia to investigate the experiences of EMS clinicians attending patients with dementia, and the experiences of carers of people with dementia when accessing English EMS

Summary

Introduction

Whilst the majority of urgent care is delivered in primary care settings, an increasing number of older people are accessing emergency medical services (EMS) and emergency departments (EDs) (The Silver Book, 2012). The oldest old are often frail; suffering from dementia, delirium or both, and if admitted for inpatient hospital care are three times more likely to die (EACSQHC, 2013). They have the highest readmission rates, and highest rate of long-term care use after discharge (Sager et al, 1996; Woodard et al, 2010). Just over 20% of older adults calling an emergency ambulance have dementia or cognitive impairment documented in their pre-hospital records (Buswell et al, 2016); and it is likely that there is an additional group of patients with undiagnosed dementia. A review by Buswell et al (2014) highlights the issue of ‘inappropriate’ calls, where an ambulance is called as the last resort or as a ‘safety net’

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