Response to ISD on Quality Outcome Measures

Consultation body

ISD

Response date

August 2011

Focus of consultation

data definitions for quality outcome 10: percentage of last 6 months spent at home or in a community setting

Acute hospitals

Many people with dementia will be admitted to acute hospitals in the months leading up to death. And we appreciate the complexity in measuring time spent in different types of community settings prior to death. This will provide an accurate measure of the proportion of time people with dementia spend at home or in a community setting prior to death, providing the full/underlying cause of death is detailed on the death certificate and the person is identified as having had dementia.

External causes of death

Alzheimer Scotland understands the exclusion of some deaths that are not relevant to the palliative care agenda. The exclusion of deaths where the principal cause is accident/injury or self harm is appropriate in this context.

We have a concern around the exclusion of falls. Falls are a major cause of morbidity and mortality in dementia. Older people with dementia have been shown to experience eight times more incident falls than those without dementia . Dementia is not always explicitly referred to as the cause of death, at least not the principle cause. This exclusion may conceal the number of people with dementia dying in acute hospitals.

We are also concerned about the exclusion of complications of medical and surgical care. The complex communication and behavioural issues in dementia can impact on the ability to diagnose complications and provide appropriate treatment. For example the inappropriate use of antipsychotic drugs and the inequitable access to analgesia for people with dementia.

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