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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
Lesley E. Williamson, Javiera Léniz, Emeka Chukwusa, Catherine Evans, Katherine E Sleeman. Age and Ageing, 2023-03-01
Topic: Risk, prevention and care in population studies
of 74,486 decedents (60.5% women; mean age 87.1 years (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) 1.02-1.13), chronic respiratory disease as the underlying cause of death (IRR 1.17, 95% CI 1.14-1.20) and urban residence (IRR 1.06, 95% CI 1.04-1.08). Higher socioeconomic position (IRR 0.92, 95% CI 0.90-0.94) and areas with higher numbers of nursing home beds (IRR 0.85, 95% CI 0.78-0.93)-but not residential home beds-were associated with fewer ED visits at the end-of-life. 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.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Williamson, L. E., Léniz, J., Chukwusa, E., Evans, C., & Sleeman, K. E. (2023). 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. Age and Ageing. https://doi.org/10.1093/ageing/afac332
Vancouver
Williamson LE, Léniz J, Chukwusa E, Evans C, Sleeman KE. 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. Age and Ageing. 2023. doi:10.1093/ageing/afac332. PMID: 36861183.
BibTeX
@article{williamson2023-36861183,
author = {Williamson, Lesley E. and Léniz, Javiera and Chukwusa, Emeka and Evans, Catherine and Sleeman, Katherine E},
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}},
journal = {Age and Ageing},
year = {2023},
doi = {10.1093/ageing/afac332},
pmid = {36861183},
url = {https://doi.org/10.1093/ageing/afac332}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- of 74,486 decedents (60.5% women; mean age 87.1 years (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) 1.02-1.13), chronic respiratory disease as the underlying cause of death (IRR 1.17, 95% CI 1.14-1.20) and urban residence (IRR 1.06, 95% CI 1.04-1.08).
- Higher socioeconomic position (IRR 0.92, 95% CI 0.90-0.94) and areas with higher numbers of nursing home beds (IRR 0.85, 95% CI 0.78-0.93)-but not residential home beds-were associated with fewer ED visits at the end-of-life. the value of nursing home care in supporting people dying with dementia to
Why it matters
In this cohort of 74,486 people who died with dementia, 82.6% had at least one emergency department visit in their last year of life. Areas with more nursing home beds were linked to fewer such visits, which the authors say supports investment in nursing home capacity so people can stay in their preferred place of care.
Study details
- Study designcohort study
- Effect size60.5%; 82.6%; RR 1.17
- Evidence strengthModerate
How this study scored 51/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Age and Ageing) |
| Journal's citation record | 2 / 4 | Age and Ageing: journal h-index 231 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 11 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.2 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 2 / 6 | Cited 2.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 1 / 4 | Cited 9 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Katherine E Sleeman: h-index 39 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | King's College London: institution h-index 1,348 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 36861183) |
| Free to read | 2 / 2 | Free to read |
| Total | 51 / 100 | — |
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