Predictors of place of death in South West Scotland 2000–2010: Retrospective cohort study

Abstract

Background:Surveys suggest most people would prefer to die in their own home.Aim:To examine predictors of place of death over an 11-year period between 2000 and 2010 in Dumfries and Galloway, south west Scotland.Design:Retrospective cohort study.Setting/Participants:19,697 Dumfries and Galloway residents who died in the region or elsewhere in Scotland. We explored the relation between age, gender, cause of death (cancer, respiratory, ischaemic heart disease, stroke and dementia) and place of death (acute hospital, cottage hospital, residential care and home) using regression models to show differences and trends. The main acute hospital in the region had a specialist palliative care unit.Results:Fewer people died in their own homes (23.2% vs 29.6%) in 2010 than in 2000. Between 2007 and 2010, men were more likely to die at home than women (p < 0.001), while both sexes were less likely to die at home as they became older (p < 0.001) and in successive calendar years (p < 0.003). Older people with dementia as the cause of death were particularly unlikely to die in an acute hospital and very likely to die in a residential home (p < 0.001). Between 2007 and 2010, an increasing proportion of acute hospital deaths occurred in the specialist palliative care unit (6% vs 11% of all deaths in the study).Conclusion:The proportion of people dying at home fell during our survey. Place of death was strongly associated with age, calendar year and cause of death. A mismatch remains between stated preference for place of death and where death occurs.

Variation in out‐of‐hospital death among palliative care inpatients across public hospitals in New South Wales, Australia

“…The rate of out‐of‐hospital death increases with age in NSW and globally, despite varying provision of palliative care in communities . The expected progression to death for the elderly and care provided by aged care facilities, which are increasingly the place of usual residence and death among the elderly versus younger individuals, might be reflected in our findings . People with better social support, for example living with families or having extended family support, often die out‐of‐hospital; data on living arrangement and social support in NSW could provide additional insight…”

Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy

“…Second, we do not account for multiple causes of death which make home deaths less likely. 25 Finally, the changes in ICD-coding systems could influence trends, but this is more of a problem in converting between earlier versions of the ICD. 42 Moreover, no breaks in the joinpoint regression are found in 1996, the year of conversion.…”

High proportion of elderly patients who are admitted to hospital are entering the last year of their lives

“…In this respect, their methodology differs from studies starting with a cohort of patients admitted to hospital who were then followed prospectively in order to determine which older people were more likely to die at home, in hospital or in residential care. Reassuringly, results of the two approaches are broadly similar 4 5. An important limitation is that people who had not been admitted to hospital within 12 months of their death were excluded from analysis.…”