Emergency Department Utilisation and Related Costs in People With and Without Dementia in Their Last Years of Life

Abstract

Objectives: To compare emergency department (ED) utilisation and related costs between people with and without dementia in their last 3 years of life (including the year of death and two full years prior to the year of death). Methods: This retrospective study used linked data (2013–2015) from 8389 people with dementia and 7813 people without dementia who died in 2015 in Queensland, Australia. ED utilisation data from the Queensland public hospitals were linked to cost data from the National Hospital Costing Data Collection using the patient's unique identifier. Two-sample t-test, Chi-square test and Generalised Estimating Equations regression were used for data analysis. Results: After adjusting for potential confounders, we show that people with dementia were more likely to have ED presentations (OR = 2.001, p < 0.01), short-stay unit admissions (OR = 1.435, p < 0.01) and arrive by ambulance (OR = 2.367, p < 0.01) than those without dementia. The average ED cost per episode for people with dementia is AUD 943.24 compared to AUD 912.82 for people without dementia, with a mean difference of AUD 30.43 (p < 0.01). ED costs for individuals with dementia were 3% higher, amounting to an estimated AUD 5 million for Australia's health sector in 2023. Conclusion: People with dementia have higher ED utilisation and costs than those without dementia. The results highlight the need for improved ED care models and targeted resource allocation to accommodate the complex needs of people with dementia.