A NIHR-funded research project led by the University of the West of England (UWE Bristol) in partnership with University Hospitals Bristol NHS Foundation Trust will look at calls to emergency services from older people with multiple health problems which include dementia.
Working with East of England Ambulance Service NHS Trust (EEAST) and South Western Ambulance Service NHS Foundation Trust (SWASFT) the 18-month project aims to analyse data, look closely at the decision making process of admitting patients to hospital and identify interventions that would reduce hospital admissions for these patients.
Every year in the UK there are approximately 8 million 999 ambulance calls and 20 million A&E attendances and the pressure is increasing on emergency services. This research will look specifically at emergency calls related to people living with dementia to establish the scale of this, the response of the ambulance services and identify ways to reduce avoidable hospital admissions.
Hospital admission can have a detrimental effect on older people who are living with dementia alongside other health problems, so for the benefit of these patients it is important to avoid unnecessary hospital admissions.
The research will first look at 2,000 anonymised ambulance service records for those aged over 65 to see why emergency services were called, how long they were at the scene and whether or not the patient was taken to hospital, stayed at home or was referred to another service.
The researchers will then shadow ambulance crews to observe cases where crews are interacting with people living with dementia and look in depth at the factors influencing the decision to admit the patient or treat them in the community. They will also interview, with their consent, the patient, family and clinical staff.
The third phase of the research will look at what interventions that might help paramedics and stakeholders keep patients out of hospital.
The research is led by Dr Sarah Voss, Associate Professor, UWE Bristol. She says, “We know that paramedics are often called to people living with dementia but we don’t know the true extent of this. We know that these call-outs may take a long time to sort out, and time is often spent on the scene making sure the person is safe. We also know that if admitted, the outcomes for people who have dementia alongside multiple other health problems tend to be worse than for others in the same age group.
“If a patient is confused and forgetful, it can be challenging for ambulance crews to establish what the main issue is. A person with dementia may call 999 because they have a headache and may remember having a fall, which would be a cause for concern. However, they may be remembering a fall that happened a week ago, but the ambulance crew has no way of knowing this unless a relative or carer is on hand to provide this information and explain the situation. This kind of contextual information could help to avoid an unnecessary a hospital admission.
“This research will give us a much better understanding of the complex decision making processes that are required of emergency services and point us in the direction of the type of intervention that might be useful – whether it is direct connections between emergency services and those with local knowledge such as relevant charities and organisations or ways of sharing information with carers or clinical staff. We hope this research will provide evidence for ways we can improve the situation for patients and for the emergency services.”
Jonathan Benger, consultant in Emergency Medicine at University Hospitals Bristol NHS Foundation Trust, said, “We fully support this research, which has the potential to lead to people with dementia being supported more effectively in their own homes, and reducing the risk that they will be admitted to hospital unnecessarily.”
The research is funded by NIHR, National Institute for Health Research, ‘Research for Patient Benefit’ scheme.