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Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers.
- Source :
- International Journal of Geriatric Psychiatry; Jul2023, Vol. 38 Issue 7, p1-11, 11p
- Publication Year :
- 2023
-
Abstract
- Objectives: Emergency department (ED) attendance is common among people with dementia and associated with poor health outcomes. Literature suggests a link between access to community care and the ED, but we know little about the mechanisms behind this link. This study aimed to explore experiences of accessing community and emergency care among people affected by dementia. Methods: Informed by critical realism, semi‐structured online and telephone interviews were conducted with people with dementia and family caregivers, with and without experience of using the ED. Participants were recruited from across the United Kingdom using purposive sampling with maximum variation. A mostly experiential reflexive thematic analysis approach was used, applying the candidacy model of access to deepen interpretation. Results: Two dyad and 33 individual interviews were conducted with 10 people with dementia, 11 current caregivers and 16 bereaved caregivers (men = 11, 70–89 years = 18, white ethnicity = 32). Three themes are reported: (1) Navigating a 'push system', (2) ED as the 'last resort', and (3) Taking dementia 'seriously'. Themes describe a discrepancy between the configuration of services and the needs of people affected by dementia, who resort to the ED in the absence of accessible alternatives. Underlying this discrepancy is a lack of systemic prioritisation of dementia and wider societal stigma. Conclusion: Although a last resort, ED attendance is frequently the path of least resistance for people with dementia who encounter multiple barriers for timely, responsive access to community health and social care. Greater systemic prioritisation of dementia as a life‐limiting condition may help to reduce reliance on the ED through essential development of post‐diagnostic care, from diagnosis to the end of life. Key points: Changing needs of people with dementia are at odds with the structural, legal, and cultural constraints of the health and social care system.Due to barriers in accessing post‐diagnostic care, emergency department attendance becomes the path of least resistance.There is a lack of parity of esteem between dementia and other life‐limiting conditions. [ABSTRACT FROM AUTHOR]
- Subjects :
- DIAGNOSIS of dementia
HEALTH services accessibility
HOSPITAL emergency services
SOCIAL support
RESEARCH methodology
TELEPHONES
COMMUNITY health services
INTERVIEWING
SOCIAL stigma
DEMENTIA patients
QUALITATIVE research
PSYCHOLOGY of caregivers
DESCRIPTIVE statistics
RESEARCH funding
JUDGMENT sampling
THEMATIC analysis
Subjects
Details
- Language :
- English
- ISSN :
- 08856230
- Volume :
- 38
- Issue :
- 7
- Database :
- Complementary Index
- Journal :
- International Journal of Geriatric Psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 167301902
- Full Text :
- https://doi.org/10.1002/gps.5966