Understanding end-of-life care for older people presenting to the ED

Grant ID: EMLE-129R31-2019-ALSABA

Project Summary

People aged ≥65 years are over-represented in the emergency department (ED) population and some, often with serious chronic disease, present in the last moment of their life. For many reasons the ED can be a challenging place to provide EoL care. The overarching aim of this study was to estimate the magnitude of the need for care at the end of life (EoL) for older people in the ED, and to describe care delivery practices, processes and outcomes for older people who present to the ED requiring EoL care. To address this aim, two phases were developed.

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Outcomes

Phase 1 involved an analysis of de-identified Health Round Table data of older persons (≥65 years) who died within 48 hours of ED presentation. The Health Round Table is an organisation that collects and profiles information from over 170 EDs and hospitals across Australia and NZ for peer comparisons and quality improvement purposes. From April 2018 to March 2019 around 10,000 older persons died within 48 hours of presenting to an ED. Around 90% arrived by ambulance and around 30% died in the ED. This phase highlights that there are a group of patients who face ‘imminent death’ when presenting to the ED, and may benefit from an EoL care service in the ED.

Phase 2 involved a more in-depth medical record review to describe care delivery practices, processes and outcomes of around 300 older persons (≥65 years) who died within 48 hours of presenting to two EDs in Queensland between April 2018 and March 2019. Around 1 in 3 were aged care facility residents. Approximately 1 in 4 older people died in the ED. From the patient factors (e.g., frailty indicators, evidence of a health-care directive), and care delivery factors (e.g., use of a 'care of the dying pathway', symptom management, family presence at the bedside) reviewed, variable practices and processes were evident. This phase highlights areas to support a 'good death' for older people at their EoL in the ED.

Together, these findings provide a basis for future research in EoL care in ED. It can increase ED clinicians’ awareness of EOL requirements and inform directions as to where to best improve quality EoL care in the ED. The multi-disciplinary team that led the undertaking of this research comprised academics and clinicians from Gold Coast Health HHS, Metro North HHS, Griffith University, Bond University and the University of Queensland.

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Dissemination

Presentation:

- Alsaba, N., Sweeny, A., May, K., Huang, Y., Grealish, L., Ranse, J., Ranse, K., Denny, K., Lukin, B., Broadbent, A., Burrows, E., Sunny, L., Khatri, M., Crilly, J., Understanding end of life care for older people presenting to the emergency department (poster presentation). 15th Asia Pacific Hospice Palliative Care Conference, Incheon, Republic of Korea, 4-7 October 2023.

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