Thijs Reyniers1, Luc Deliens2, H Roeline Pasman3, Lucas Morin4, Julia Addington-Hall5, Luisa Frova6, Marylou Cardenas-Turanzas7, Bregje Onwuteaka-Philipsen3, Wayne Naylor8, Miguel Ruiz-Ramos9, Donna M Wilson10, Martin Loucka11, Agnes Csikos12, Yong Joo Rhee13, Joan Teno14, Joachim Cohen15, Dirk Houttekier15. 1. Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium. Electronic address: Thijs.reyniers@vub.ac.be. 2. Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium. 3. Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands. 4. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; French National Observatory on End-of-Life Care, Paris, France. 5. Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK. 6. National Institute of Statistics, Rome, Italy. 7. MD Anderson Cancer Center Department of Leukemia, University of Texas, Houston, TX. 8. Hospice Waikato, Hillcrest, Hamilton, New Zealand. 9. Department of Information and Evaluation, Regional Ministry of Equality, Health and Social Policies in Andalusia, Seville, Spain. 10. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. 11. Center for Palliative Care, Prague, Czech Republic. 12. University of Pécs Medical School, Pécs, Hungary. 13. Department of Health Sciences, Dongduk Women's University, Seoul, South Korea. 14. Brown University, School of Public Health, Providence, RI. 15. Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
Abstract
OBJECTIVES: The objective of this study was to examine variation in place of death of older people dying from dementia in countries across 4 continents. DESIGN: Study of death certificate data. METHODS: We included deaths of older (65 + years) people whose underlying cause of death was a dementia-related disease (ICD-10: F01, F02, F03, G30) in Belgium, the Netherlands, England, Wales, France, Italy, Spain, Czech Republic, Hungary, New Zealand, United States, Canada, Mexico and South Korea. We examined associations between place of death and sociodemographic factors, social support, and residential and health care system factors. RESULTS: Overall, 4.8% of all deaths were from a dementia-related disease, ranging from 0.4% in Mexico to 6.9% in Canada. Of those deaths, the proportion occurring in hospital varied from 1.6% in the Netherlands to 73.6% in South Korea. When controlling for potential confounders, hospital death was more likely for men, those younger than 80, and those married or living in a region with a higher availability of long-term care beds, although this could not be concluded for each country. Hospital death was least likely in the Netherlands compared with other countries. CONCLUSIONS: Place of death of older people who died from a dementia-related disease differs substantially between countries, which might point to organizational differences in end-of-life care provision. Increasing the availability of long-term care beds might be important to reduce the number of hospital deaths, while focusing specialized end-of-life care services on married people or those aged 65 to 79 might be crucial for achieving home death. However, proper end-of-life care needs to be ensured in hospitals, should this be the most appropriate end-of-life care setting.
OBJECTIVES: The objective of this study was to examine variation in place of death of older people dying from dementia in countries across 4 continents. DESIGN: Study of death certificate data. METHODS: We included deaths of older (65 + years) people whose underlying cause of death was a dementia-related disease (ICD-10: F01, F02, F03, G30) in Belgium, the Netherlands, England, Wales, France, Italy, Spain, Czech Republic, Hungary, New Zealand, United States, Canada, Mexico and South Korea. We examined associations between place of death and sociodemographic factors, social support, and residential and health care system factors. RESULTS: Overall, 4.8% of all deaths were from a dementia-related disease, ranging from 0.4% in Mexico to 6.9% in Canada. Of those deaths, the proportion occurring in hospital varied from 1.6% in the Netherlands to 73.6% in South Korea. When controlling for potential confounders, hospital death was more likely for men, those younger than 80, and those married or living in a region with a higher availability of long-term care beds, although this could not be concluded for each country. Hospital death was least likely in the Netherlands compared with other countries. CONCLUSIONS: Place of death of older people who died from a dementia-related disease differs substantially between countries, which might point to organizational differences in end-of-life care provision. Increasing the availability of long-term care beds might be important to reduce the number of hospital deaths, while focusing specialized end-of-life care services on married people or those aged 65 to 79 might be crucial for achieving home death. However, proper end-of-life care needs to be ensured in hospitals, should this be the most appropriate end-of-life care setting.
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Authors: Richard Harding; Stefano Marchetti; Bregje D Onwuteaka-Philipsen; Donna M Wilson; Miguel Ruiz-Ramos; Maria Cardenas-Turanzas; YongJoo Rhee; Lucas Morin; Katherine Hunt; Joan Teno; Cecilia Hakanson; Dirk Houttekier; Luc Deliens; Joachim Cohen Journal: BMC Infect Dis Date: 2018-01-25 Impact factor: 3.090