The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand

Amy L Sweeny; Nemat Alsaba; Laurie Grealish; Kerina Denny; Bill Lukin; Andrew Broadbent; Ya-Ling Huang; Jamie Ranse; Kristen Ranse; Katya May; Julia Crilly

doi:10.1093/ageing/afae067

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The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand

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The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand

Amy L Sweeny, Nemat Alsaba, Laurie Grealish, Kerina Denny, Bill Lukin, Andrew Broadbent, Ya-Ling Huang, Jamie Ranse, Kristen Ranse, Katya May, …

Age and ageing, Vol.53(4)

04/2024

DOI: https://doi.org/10.1093/ageing/afae067

PMID: 38594928

Appears in Recent Faculty of Health Publications

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Abstract

Aged

Emergency care

Palliative care

End-of-life care

Epidemiology

Older people

Background Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. Objectives To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. Methods We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. Results From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31–6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65–74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Conclusions Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens.

Details

Title: The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand
Creators: Amy L Sweeny - Griffith University
Nemat Alsaba - Bond University
Laurie Grealish - Griffith University
Kerina Denny - Gold Coast University Hospital
Bill Lukin - University of Queensland
Andrew Broadbent - Bond University
Ya-Ling Huang - Southern Cross University
Jamie Ranse - Gold Coast University Hospital
Kristen Ranse - Griffith University
Katya May - Gold Coast University Hospital
Julia Crilly - Griffith University
Publication Details: Age and ageing, Vol.53(4)
Publisher: Oxford University Press
Grant note: EMLE-129R31-2019 / Emergency Medicine Foundation
Identifiers: 991013179908802368
Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Academic Unit: Nursing; Faculty of Health
Language: English
Resource Type: Journal article