{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:21:07Z","timestamp":1788895267107,"version":"build-2803163510"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"oyal Marsden Partners Pan London Research Fellowship Award"},{"name":"NIHR Clinician Scientist Fellowship","award":["CS-2015-15-005"],"award-info":[{"award-number":["CS-2015-15-005"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["ICA-SCL-2015-01-001"],"award-info":[{"award-number":["ICA-SCL-2015-01-001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Applied Research Collaboration South London"},{"DOI":"10.13039\/100010377","name":"National Institute for Health and Care Excellence","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010377","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Royal Marsden Partners"},{"DOI":"10.13039\/100009360","name":"King\u2019s College London","doi-asserted-by":"publisher","award":["BRC-1215-20,018"],"award-info":[{"award-number":["BRC-1215-20,018"]}],"id":[{"id":"10.13039\/100009360","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004426","name":"The Atlantic Philanthropies","doi-asserted-by":"crossref","award":["24611"],"award-info":[{"award-number":["24611"]}],"id":[{"id":"10.13039\/100004426","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Cicely Saunders International"},{"DOI":"10.13039\/501100000143","name":"Alzheimer Society","doi-asserted-by":"publisher","award":["AS-CP-18-002"],"award-info":[{"award-number":["AS-CP-18-002"]}],"id":[{"id":"10.13039\/501100000143","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>emergency department (ED) visits have inherent risks for people with dementia yet increase towards the end-of-life. Although some individual-level determinants of ED visits have been identified, little is known about service-level determinants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>to examine individual- and service-level factors associated with ED visits by people with dementia in the last year of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>retrospective cohort study using hospital administrative and mortality data at the individual-level, linked to health and social care service data at the area-level across England. The primary outcome was number of ED visits in the last year of life. Subjects were decedents with dementia recorded on the death certificate, with at least one hospital contact in the last 3 years of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>of 74,486 decedents (60.5% women; mean age 87.1\u2009years (standard deviation: 7.1)), 82.6% had at least one ED visit in their last year of life. Factors associated with more ED visits included: South Asian ethnicity (incidence rate ratio (IRR) 1.07, 95% confidence interval (CI) 1.02\u20131.13), chronic respiratory disease as the underlying cause of death (IRR 1.17, 95% CI 1.14\u20131.20) and urban residence (IRR 1.06, 95% CI 1.04\u20131.08). Higher socioeconomic position (IRR 0.92, 95% CI 0.90\u20130.94) and areas with higher numbers of nursing home beds (IRR 0.85, 95% CI 0.78\u20130.93)\u2014but not residential home beds\u2014were associated with fewer ED visits at the end-of-life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>the value of nursing home care in supporting people dying with dementia to stay in their preferred place of care must be recognised, and investment in nursing home bed capacity prioritised.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ageing\/afac332","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T12:43:47Z","timestamp":1677761027000},"source":"Crossref","is-referenced-by-count":11,"title":["A population-based retrospective cohort study of end-of-life emergency department visits by people with dementia: multilevel modelling of individual- and service-level factors using linked data"],"prefix":"10.1093","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-7498","authenticated-orcid":false,"given":"Lesley E","family":"Williamson","sequence":"first","affiliation":[{"name":"Cicely Saunders Institute King\u2019s College London, , London SE5 9PJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9315-4871","authenticated-orcid":false,"given":"Javiera","family":"Leniz","sequence":"additional","affiliation":[{"name":"Departamento de Salud P\u00fablica, Escuela de Medicina, Pontificia Universidad Cat\u00f3lica de , Santiago , Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emeka","family":"Chukwusa","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute King\u2019s College London, , London SE5 9PJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0034-7402","authenticated-orcid":false,"given":"Catherine J","family":"Evans","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute King\u2019s College London, , London SE5 9PJ , UK"},{"name":"Sussex Community NHS Foundation Trust, Brighton General Hospital , Brighton BN2 3EW , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E","family":"Sleeman","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute King\u2019s College London, , London SE5 9PJ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"2023030206492844800_","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/WAD.0000000000000118","article-title":"Emergency department use among older adults with dementia","volume":"30","author":"LaMantia","year":"2016","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"2023030206492844800_","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jalz.2017.06.2267","article-title":"Predictors of emergency department attendance by people with dementia in their last year of life: retrospective cohort study using linked clinical and administrative data","volume":"14","author":"Sleeman","year":"2018","journal-title":"Alzheimers Dement"},{"key":"2023030206492844800_","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1111\/j.1532-5415.2012.04108.x","article-title":"Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research","volume":"60","author":"Clevenger","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"2023030206492844800_","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1136\/bmjspcare-2011-000178","article-title":"Barriers to providing end-of-life care for people with dementia: a whole-system qualitative study","volume":"2","author":"Dening","year":"2012","journal-title":"BMJ Support Palliat Care"},{"key":"2023030206492844800_","volume-title":"End of Life Care for Adults. 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