Why Did an Out-of-Hospital Shift of Death and Dying Occur in Canada after 1994?

Abstract

Canadian population mortality data reveal a significantly reduced proportion of deaths occurring in hospitals after 1994. Hospital deaths peaked at 80.5% in 1994, after a longstanding hospitalization-of-death trend in Canada. A decline in hospital-based death and dying has also occurred in some other countries. As the place of death can have multiple significant direct and indirect impacts on dying individuals, their families, and health services utilization and costs, it is important to understand factors for an out-of-hospital shift. An integrative review of Canadian print literature from 1995 was undertaken to identify these factors, with three themes emerging: (1) changes in health care and health system reforms after 1994 reduced both the availability and desirability of hospital-based care, (2) sociodemographic developments including aging of the population, increased multiculturalism, and diversity in accepted end-of-life care practices shifted place preferences, and (3) advances in palliative and end-of-life care, including a palliative care expansion out of hospital, supported nonhospital death, and dying processes. The period following 1994 was thus a time of major transformation during which the place of death and dying underwent important changes that supported and promoted a transition from hospital-based end-of-life care.

Dying among older adults in Switzerland: who dies in hospital, who dies in a nursing home?

“…However, there is some indication of changing trends in place of death in the past years [ 3 ]. Wilson et al (2014) examined factors associated with shifts in deaths outside hospital in Canada after 1994 which appear to be related to socio-demographic developments, changes in the health care systems as well as improvement in EOL services over the years [ 11 ].…”

The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying

“…It is also possible that palliative care advancements over the last two decades in British Columbia and elsewhere across Canada have been influential for this shift of death and thus also EOL care out of hospital, as advancements in palliative knowledge, skills, equipment, and services have been considerable in recent years. Indeed, a recent literature review identified palliative care developments as one of three primary influences for deaths to be increasingly taking place outside of Canadian hospitals [19]. Another influence was determined to be a reduction in the actual availability of hospital beds as a consequence of cross-Canada hospital bed closures, coupled with the reduced social desirability of hospital-based EOL care [19].…”

“…Indeed, a recent literature review identified palliative care developments as one of three primary influences for deaths to be increasingly taking place outside of Canadian hospitals [19]. Another influence was determined to be a reduction in the actual availability of hospital beds as a consequence of cross-Canada hospital bed closures, coupled with the reduced social desirability of hospital-based EOL care [19]. The third influence was identified as recent socio-demographic developments, notably population aging, increased multiculturalism, and more social acceptance of dying-all of which have contributed to a greater diversity in accepted EOL care practices as well as a change the general public's EOL care preferences [19].…”

“…Another influence was determined to be a reduction in the actual availability of hospital beds as a consequence of cross-Canada hospital bed closures, coupled with the reduced social desirability of hospital-based EOL care [19]. The third influence was identified as recent socio-demographic developments, notably population aging, increased multiculturalism, and more social acceptance of dying-all of which have contributed to a greater diversity in accepted EOL care practices as well as a change the general public's EOL care preferences [19]. It is well established now that most people would prefer to die at home, if they have that choice available to them [20].…”

Everyday activities when living at home with advanced cancer: A cross‐sectional study

“…As health care for people with advanced cancer has shifted towards outpatient treatment combined with homecare provision (The Danish Government, 2016; Wilson, Hewitt, Thomas, & Woytowich, 2014), they predominantly spend time at home (la Cour, Nordell, & Josephsson, 2009). Consequently, as more people with advanced cancer live for a longer period, an increasing number of individuals is expected to spend more time at home with decreased ability to perform and participate in needed and desirable everyday activities.…”