Abstract
Background: England has one of the highest rates of hospital death in dementia in Europe. How this has changed over time is unknown. This study aimed to analyse temporal trends in place of death in dementia over a recent ten year period.Methods: Population-based study linking Office for National Statistics mortality data with regional variables, in England 2001-2010. Participants were adults aged over 60 with a death certificate mention of dementia. Multivariable Poisson regression was used to determine the proportion ratio (PR) for death in care home (1) and home/hospice (1) compared to hospital (0). Explanatory variables included individual factors (age, gender, marital status, underlying cause of death), and regional variables derived at area level (deprivation, care home bed provision, urbanisation).Results: 388,899 deaths were included. Most people died in care homes (55.3%) or hospitals (39.6%). A pattern of increasing hospital deaths reversed in 2006, with a subsequent decrease in hospital deaths (-0.93% per year, 95% CI -1.08 to -0.79 p < 0.001), and an increase in care home deaths (0.60% per year, 95% CI 0.45 to 0.75 p < 0.001). Care home death was more likely with older age (PR 1.11, 1.10 to 1.13), and in areas with greater care home bed provision (PR 1.82, 1.79 to 1.85) and affluence (PR 1.29, 1.26 to 1.31). Few patients died at home (4.8%) or hospice (0.3%). Home/hospice death was more likely in affluent areas (PR 1.23, 1.18 to 1.29), for women (PR 1.61, 1.56 to 1.65), and for those with cancer as underlying cause of death (PR 1.84, 1.77 to 1.91), and less likely in the unmarried (PRs 0.51 to 0.66).Conclusions: Two in five people with dementia die in hospital. However, the trend towards increasing hospital deaths has reversed, and care home bed provision is key to sustain this. Home and hospice deaths are rare. Initiatives which aim to support the end of life preferences for people with dementia should be investigated.
Original language | English |
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Article number | 59 |
Journal | BMC Neurology |
Volume | 14 |
Issue number | 1 |
DOIs | |
Publication status | Published - 26 Mar 2014 |
Bibliographical note
Funding Information:The GUIDE_Care project was funded by the National Institute for Health Research Health Services and Delivery Research(NIHR HS&DR) programme (Project number 09/2000/58). Investigators: Irene Higginson, Wei Gao, Julia Verne, Myer Glickman, Barbara Gomes. Visit the HS&DR website for more information. The project is part of a larger programme investigating care at the end of life and place of death, which has support from Cicely Saunders International and NIHR. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS or the Department of Health. We thank the following members of the Project Advisory Group: Tony Bonser, Shaheen Khan, Jonathan Koffman, Katie Lindsey, Roberta Lovick, Tariq Malik, Carolyn Morris, Andy Pring, Stafford Scholes. We thank the ONS for supplying data. We thank Claudia Wells, Vanessa Fearn and Julie Messer of the ONS for their advice and support in the preparation of the data for analysis.
Keywords
- Dementia
- Hospitals
- Location of death
- Nursing homes
- Terminal care