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  • Deaths at home during the Covid-19 pandemic and implications for patients and services (5 April 2023)


    • UK
    • Data, research and analysis
    • Pre-existing
    • Original author
    • No
    • Eilís Keeble, Sarah Scobie, Theo Georghiou, Miranda Davies
    • 05/04/23
    • Health and care staff, Patient safety leads, Researchers/academics

    Summary

    There has been a steady increase in the numbers of people dying at home in recent years. These trends became entrenched during the pandemic, which could reflect people fearful of Covid-19 in hospitals and care homes just as much as broader patient preferences for dying at home. So did those dying at home receive the care they needed, at a good standard? This new research from the Nuffield Trust sheds light on the services used by people who died at home in England, before and during the first year of the pandemic.

    Content

    Key findings

    • The pandemic exacerbated socioeconomic inequalities in service use. People from the most deprived areas who died at home used less of almost all services than people from the least deprived areas, and were prescribed fewer medications for symptom management. For general practice interactions the difference grew during the pandemic, with people from the most deprived areas having almost one whole interaction less than people from the least deprived areas.
    • People from Asian ethnic backgrounds were more likely to use hospital beds in an emergency and to use general practice services before the pandemic. While general practice interactions increased for all ethnic groups during the pandemic, the increase was largest for people from white ethnic backgrounds.
    • People who died at home were less likely to have planned hospital admissions during the pandemic, with 4.8% having at least one admission during the pandemic compared with 5.3% pre-pandemic. People who died from circulatory diseases also had fewer outpatient appointments during the pandemic. These differences reflect reductions in planned care across the board, as the NHS focused on responding to Covid-19, but for people approaching the end of life, the reductions were not just a matter of delaying care.
    • Conversely, there was an increase in the use of Accident & Emergency (A&E) during the pandemic for people who died at home, particularly for people who died from dementia and Alzheimer’s disease. For this group, the proportion of people who had at least one A&E visit in the last month of life increased from 12% to 15% and there was also an increase in how often people went. 
    • Use of general practice increased during the pandemic among people who died at home. The proportion of people with at least one general practice interaction in the last month of life rose from 64% pre-pandemic to 75% during the pandemic and the number of interactions per person also increased, from 2.5 to 3.8.
    • People who died at home during the pandemic were more likely to be prescribed at least one medication for symptom management than people who died at home before the pandemic (38% vs 34%) and the number of medications prescribed per person increased from 1.3 to 1.5 between the pre-pandemic and pandemic periods. However, our patient and public involvement group highlighted that patients and families were not always clear what different medications were for, and wanted more support surrounding the use of medications, particularly when a syringe driver was needed.
    Deaths at home during the Covid-19 pandemic and implications for patients and services (5 April 2023) https://www.nuffieldtrust.org.uk/research/deaths-at-home-during-the-covid-19-pandemic-and-implications-for-patients-and-services
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