OBJECTIVES: To portray the changes in the place of death of South Australians during the 20th century and to examine the effects of sociodemographic and cause of death variables. DESIGN: Data relating to 2566 deaths from 1910 to 1987 were extracted from the records of funeral directors. A comparison of our sample of deaths with State mortality statistics, in terms of age, sex and diagnosis, was made to assure the representativeness of the sample. RESULTS: The proportion of deaths which occurred at home decreased from 55.6% in 1910 to 26.2% in 1970, and thereafter about a quarter of all deaths occurred at home. Most of the "institutionalisation of death" was due to increasing proportions of deaths in public hospitals; by 1970 over two-thirds of all deaths occurred in hospitals. After 1970 death has been transferred from hospitals to nursing homes and inpatient hospices. Multivariate analyses indicated that the institutionalisation trend was present after taking account of confounders (age, sex, marital status, occupation, number of children, and cause of death). CONCLUSIONS: Mortality patterns are determined by social and demographic characteristics of those who die, the availability of hospital and nursing home beds, changes to health insurance schemes, and the emergence of hospice care and related services. Further study is required to determine whether patterns of terminal care are cost-effective and medically appropriate.
OBJECTIVES: To portray the changes in the place of death of South Australians during the 20th century and to examine the effects of sociodemographic and cause of death variables. DESIGN: Data relating to 2566 deaths from 1910 to 1987 were extracted from the records of funeral directors. A comparison of our sample of deaths with State mortality statistics, in terms of age, sex and diagnosis, was made to assure the representativeness of the sample. RESULTS: The proportion of deaths which occurred at home decreased from 55.6% in 1910 to 26.2% in 1970, and thereafter about a quarter of all deaths occurred at home. Most of the "institutionalisation of death" was due to increasing proportions of deaths in public hospitals; by 1970 over two-thirds of all deaths occurred in hospitals. After 1970 death has been transferred from hospitals to nursing homes and inpatient hospices. Multivariate analyses indicated that the institutionalisation trend was present after taking account of confounders (age, sex, marital status, occupation, number of children, and cause of death). CONCLUSIONS: Mortality patterns are determined by social and demographic characteristics of those who die, the availability of hospital and nursing home beds, changes to health insurance schemes, and the emergence of hospice care and related services. Further study is required to determine whether patterns of terminal care are cost-effective and medically appropriate.