What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death

Anna E. Bone*, Barbara Gomes, Simon N. Etkind, Julia Verne, Fliss E.M. Murtagh, Catherine J. Evans, Irene J. Higginson

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    149 Citations (Scopus)


    Background: Population ageing represents a global challenge for future end-of-life care. Given new trends in place of death, it is vital to examine where the rising number of deaths will occur in future years and implications for health and social care. Aim: To project where people will die from 2015 to 2040 across all care settings in England and Wales. Design: Population-based trend analysis and projections using simple linear modelling. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and ‘other’ were applied to numbers of expected future deaths. Setting/population: All deaths (2004–2014) from death registration data and predicted deaths (2015–2040) from official population forecasts in England and Wales. Results: Annual deaths are projected to increase from 501,424 in 2014 (38.8% aged 85 years and over) to 635,814 in 2040 (53.6% aged 85 years and over). Between 2004 and 2014, proportions of home and care home deaths increased (18.3%–22.9% and 16.7%– 21.2%) while hospital deaths declined (57.9%–48.1%). If current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023. Conclusion: To sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.

    Original languageEnglish
    Pages (from-to)329-336
    Number of pages8
    JournalPalliative Medicine
    Issue number2
    Publication statusPublished - 1 Feb 2018

    Bibliographical note

    Funding Information:
    The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work is independent research funded by Cicely Saunders International and The Atlantic Philanthropies (grant number 24610). This research was supported by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, which is part of the National Institute for Health Research (NIHR), and is a partnership between King’s Health Partners, St. George’s, University London and St George’s Healthcare NHS Trust. I.J.H. is an NIHR Senior Investigator. C.J.E. is funded by a Health Education England (HEE)/NIHR Senior Clinical Lectureship. B.G. is funded by the Calouste Gulbenkian Foundation. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

    Publisher Copyright:
    © 2017, © The Author(s) 2017.


    • Aged
    • forecasting
    • health services need and demand
    • mortality
    • palliative care


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