Emergency admissions from care home to hospital in the last week of life: an analysis of national data for England between 2006 and 2015

Problem

Hospital admissions of care home residents close to the end of life are a source of concern, frequently described as “inappropriate” and often attributed to suboptimal care in the community. 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.

Approach

Longitudinal and cross-sectional analysis of linked Hospital Episode Statistics with ONS mortality data for England 2006 to 2015. The study included 185,830 care home residents aged 25+ who experienced a last week of life emergency admission to hospital and a comparator group comprising 903,175 care home residents who died in care homes.

Findings

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. Trend analysis revealed significant decreases in these admissions from 2008 onwards. 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.

Consequences

Most care home residents in the last week of life remain and die in their care home: a small and decreasing proportion are admitted to hospital in their final week of life. This analysis of a large national dataset challenges the widespread perception that care home resident end of life admissions are numerous and present a major problem to hospital services. With an ageing population, that often approach the end of life with physical and cognitive frailty, the considerable implications for GPs, community nurses, service managers and health and social care policy makers are discussed.