Patterns and predictors of place of cancer death for the oldest old

Lock, Anna; Higginson, Irene J

doi:10.1186/1472-684x-4-6

Cited by 42 publications

(43 citation statements)

References 25 publications

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“…Other previous study findings are not directly comparable, as they include wider age ranges or focus on cancer deaths. 31,32 A recent study roughly contemporary with the present one, reporting ≥85 year olds' all-cause mortality trends in England and Wales, could not detail different institutional settings separately but found very similar levels and declines in home deaths. 21 In Wales, trends over two decades showed the numbers of hospital deaths in individuals aged ≥85 years had doubled, care home deaths tripled, and deaths in the community were down by one-third.…”

Section: Comparison With Existing Literaturementioning

confidence: 82%

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Fleming

Zhao²,

Farquhar³

et al. 2010

Br J Gen Pract

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Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. AimTo examine the place of residence or care of ≥85 yearolds less than a year before death, and their place of death, and to map individual changes between the two. Design of studyPopulation-based cohort study. SettingCambridge City over-75s Cohort (CC75C) study, UK. MethodRetrospective analysis of prospective data from males and females aged ≥85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. ResultsOnly 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. ConclusionMore than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old. Keywords aged; aged 80 or over; aging in place; frail elderly; terminal care. INTRODUCTIONEnd-of-life care for older people is now an acknowledged priority.1 Recent UK policy initiatives and reports recognise the increasing number of people who will be dying in very old age.2-5 Emphasis on a care pathway approach highlights the importance of the place of care, place of death, and transitions between them.6-8 The NHS End of Life Care Programme's aims include reducing emergency admissions and transfers from care homes to hospital in the last week of life, alongside providing the support needed to enable people to die where they choose. 9 The policy drive to facilitate 'good deaths' at home envisages savings on costly acute care, enhancing value for money at the same time as choice, quality, and equality. 2,10,11 In many developed countries, deaths, including inhospital deaths, are rising fastest among ≥85-year olds. 1,12,13 Data are scarce on older people's place of care trajectories before death,

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Section: Comparison With Existing Literaturementioning

confidence: 82%

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Fleming

Zhao²,

Farquhar³

et al. 2010

Br J Gen Pract

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“…The individual characteristics of those who died in a deprived area may not relate to the social characteristics of that area (Winkleby et al, 2006). For example the location of retirement or care homes could affect our results through increasing the level of inequality, or masking any decrease at older ages (Lock and Higginson, 2005). The deprivation quintiles were kept constant, which assumed areas remained fixed in terms of whether they are deprived or not.…”

Section: Discussionmentioning

confidence: 99%

The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010

Green¹

2013

Social Science & Medicine

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The equalisation hypothesis argues that during adolescence and early adulthood, inequality in mortality declines and begins to even out. However the evidence for this phenomenon is contested and mainly based on old data. This study proposes to examine how age-specific inequalities in mortality rates have changed over the past decade, during a time of widening health inequalities. To test this, mortality rates were calculated for deprivation quintiles in England, split by individual ages and sex for three time periods (2002-2004, 2005-2007 and 2008-2010). The results showed evidence for equalisation, with a clear decline in the ratio of mortality rates during late adolescence. However this decline was not accounted for by traditional explanations of the hypothesis. Overall, geographical inequalities were shown to be widening for the majority of ages, although there was some narrowing of patterns observed.

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“…In the United Kingdom and many countries, older people with cancer are less likely to die at home and in inpatient hospices. 46 Indeed, in the United Kingdom, hospital is the most common place of death up to the age of 90 years when nursing home takes over. 46 Diversely, in New York and in Singapore, home deaths increase with age.…”

Section: What Factors Are Associated With Home Care and Home Death?mentioning

confidence: 99%

“…46 Indeed, in the United Kingdom, hospital is the most common place of death up to the age of 90 years when nursing home takes over. 46 Diversely, in New York and in Singapore, home deaths increase with age. 41,47 In order to enable more cancer patients to die at home and to tackle inequities, an understanding of the factors associated with death at home is required.…”

Section: What Factors Are Associated With Home Care and Home Death?mentioning

confidence: 99%

Dying at home – is it better: A narrative appraisal of the state of the science

et al. 2013

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Background: Achieving home care and home death is increasingly used as an outcome measure of palliative care services. Aim: To appraise the state of the science on dying at home. Methods: Appraisal and narrative review developed from a plenary presentation at the European Association for Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place of death, factors associated with dying in the preferred place, presenting evidence on outcomes for those dying at home and suggesting future research questions. Results: Meeting patients' preferences and creating home-like environments has been a major concern for hospice and palliative care since its inception. During the 20 th century, in many countries, hospital deaths increased and home deaths reduced. Despite the fact that this trend has been halted or reversed in some countries (notably the United States, Canada and, more recently, the United Kingdom) in the last 5-20 years, a home death is still a distant reality for the majority, even though evidence shows it is the most commonly preferred place to die. Epidemiological studies identified factors associated with home death, including affluence, patients' preferences, provision of home care and extended family support. Evidence about the benefits of home care is conflicting, but recent data suggest that holistic well-being may be greater at home. Implications: We call for further analyses of variations in place of care and place of death and robust studies on how patients and families formulate and change preferences over time. Regular monitoring of outcomes, quality and costs of palliative home care is urged.

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Patterns and predictors of place of cancer death for the oldest old

Cited by 42 publications

References 25 publications

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010

Dying at home – is it better: A narrative appraisal of the state of the science

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