Potentially Avoidable Visits to the Emergency Department by Patients With Dementia at the End of Life – a Longitudinal Retrospective Study

Background Preventing avoidable visits to the Emergency department (ED) by patients with dementia (PwD) at the end of life, reduces the harm associated with them and potentially improves end of life care itself. The aim of this study was to evaluate the prevalence of potentially avoidable ED visits by PwD at the end of life, its main reasons and associated factors. Methods Retrospective study performed at a 24h/7d polyvalent ED of a university hospital in northern Portugal. Adult patients with an established diagnosis of Alzheimer’s disease or other related dementias, who died between January 1 and December 31, 2021, in this hospital and visited the ED in the 12 months before their death, were included. Sociodemographic, clinical and ED related variables were collected from the patients’ electronic process. Potentially avoidable ED visits were assessed by Cornillon et al criteria and unmet PC needs by the Palliative Care and Rapid Emergency Screening tool. The chi-square test was used to analyse the possible relationships between independent variables and potentially avoidable ED visits. Results In this study we report a 24,2% prevalence of potentially avoidable visits to the ED by PwD at the end of life. Infection, behavioural changes related to dementia and constipationstand out as the main reasons for these potentially avoidable ED visits. The prevalence of unmet palliative care needs in PwD with avoidable ED visits was not only high but also significantly greater than in patients with nonavoidable ED visits (p < 0.05). Conclusions Potentially avoidable visits to the ED by PwD at the end of life were high and associated with the presence of unmet PC needs. Improving responses to PC needs, even in the ED, could contribute to reduce avoidable ED visits.