Reversal of the British trends in place of death: Time series analysis 2004–2010
From Palliative Medicine
Although around two thirds of us would prefer to die at home, in the developed world the trend in recent years has been for the majority to spend their final days in an institutional setting. But according to this study the tide has now turned and an increasing number of people in the UK are dying at home. In this study, the researchers analyzed death registration data from the UK Office for National Statistics for all those who had died between 2004 and 2010 – over 3.5 million records. The team found that, following trends in the USA and Canada, dying at home is now also becoming more prevalent in Britain. Earlier research drew attention to the gaps between preferences and actuality, which changed Government policy, leading to greater emphasis on meeting patient preferences. Although more of the very elderly are dying at home based on these ONS statistics, the most elderly in Britain continue to have fewer chances to die at home than other age group.
Even for those who do die at home, little evidence has been gathered to establish whether they, and their relatives, experience better care than those who die in institutions such as hospitals, hospices or nursing homes.
Background: Increased attention is being paid to the place where people die with a view to providing choice and adequately planning care for terminally ill patients. Secular trends towards an institutionalised dying have been reported in Britain and other developed world regions.
Aim: This study aimed to examine British national trends in place of death from 2004 to 2010.
Design and setting: Descriptive analysis of death registration data from the Office for National Statistics, representing all 3,525,564 decedents in England and Wales from 2004 to 2010.
Results: There was a slow but steady increase in the proportion of deaths at home, from 18.3% in 2004 to 20.8% in 2010. Absolute numbers of home deaths increased by 9.1%, whilst overall numbers of deaths decreased by 3.8%. The rise in home deaths was more pronounced in cancer, happened for both genders and across all age groups, except for those younger than 14 years and for those aged 65–84, but only up to 2006. The rise was more evident when ageing was accounted for (age–gender standardised proportions of home deaths increased from 20.6% to 23.5%).
Conclusions: Following trends in the USA and Canada, dying is also shifting to people’s homes in Britain. Home deaths increased for the first time since 1974 amongst people aged 85 years and over. There is an urgent need across nations for comparative evidence on the outcomes and the costs of dying at home.
Gomes, B., Calanzani, N., & Higginson, I. (2012). Reversal of the British trends in place of death: Time series analysis 2004-2010 Palliative Medicine DOI: 10.1177/0269216311432329