Where older people die: a retrospective population-based study

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Abstract
Background: Palliative medicine services have invested in the community to support people dying at home. To develop end-of-life care for older people, we need to know where they die. Aim: To examine trends in age and location of death over the last 20 years. Design: Retrospective death certificate review. Method: All Wales death certificates from 1981 to 2001 were examined. Place of death and age were noted. Results: Total deaths decreased from 35 015 in 1981 to 32 966 in 2001, and mortality decreased from 12.45 per 1000 population in 1981 to 11.33 in 2001. Deaths in the community decreased from 37.6% (n = 13 155) to 22.1% (n = 7293) (p < 0.001); deaths increased in hospital from 56.7% (n = 19 871) to 61.7% (n = 20 334) (p < 0.001) and in care homes from 5.7% (n = 1989) to 16.2% (n = 5339) (p < 0.001). Between 1981 and 2001, deaths in those aged 65–74 years dropped from 9752 to 6361, but increased in the over-85s from 5661 to 9779. Deaths amongst 75–84-year-olds remained stable at around 11 000. The biggest rise in hospital and care-home deaths was in those over 85: hospital deaths increased from 2928 in 1981, to 5438 in 2001; care-home deaths increased from 941 to 3141. Discussion: The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. End-of-life needs for older people need to be addressed in hospital and care homes, not just in the community.