The role of ambulance services in urgent and emergency care pathways for people with dementia

The old age theme of CLAHRC-CP are conducting a critical scoping review:  ‘What role do ambulance services play in urgent and emergency care pathways for people with dementia?’ with two experienced paramedics as co-reviewers. We have held discussion workshops with carers and frontline staff. We have almost completed this review and are in the process of writing up our findings.

There is a scarcity of peer reviewed research literature. We found 24 documents with something to say on the subject half from the grey literature. Each document was categorised according to the ‘Lens’ i.e. the authors’ perspective and the role of the ambulance service described. We identified three main roles, ‘emergency transport’, ‘assess, treat, manage’ and ‘last resort/safety net’.  In three papers the ambulance service role was not considered when we thought it should have been.

We concluded that there is a need to triangulate research efforts and priorities to fill in the missing gaps between academic research disciplines. Researchers in dementia care should ask, ‘Is it relevant to ask about the ambulance service in this research?’ Researchers in prehospital urgent and emergency care should ask, ‘Would it be relevant to ask about the impact of dementia in the scenarios we are investigating?’ Research needs to catch up with what the grey literature is telling us and to test the recommendations and best practice guidance. The results of the systematic review are expected in the autumn 2013.

We are also providing support to evaluate a newly formed Acute Geriatric Early Intervention Service (AGEIS), a collaborative initiative between Cambridgeshire Community Services and the East of England Ambulance Service. It is a multidisciplinary team which comprises of ambulance clinicians, physiotherapy, occupational therapy and a consultant geriatrician. The aim of the service is to avert inappropriate hospital admissions for elderly patients who are in or at risk of imminent crisis which would likely result in an acute admission. It delivers an immediate response to the multi-faceted issues of the elderly, bringing together services that have previously worked independently. The service responds to 999 calls from over 65s and accepts direct referrals from GP’s against set criteria.

“There is an embarrassing paucity of research into the needs of frail older people in general, and hardly any directly relevant research addressing urgent care… Given the dearth of research on the urgent care needs of frail older people, there is considerable scope to develop a substantial body of work addressing this issue. This is likely to need to start with developing an in-depth understanding of the issues, from the person, carer, professional and system perspective.”


Useful links

The Silver Book: Quality Care for Older People with Urgent & Emergency Care Needs