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New health services needed for rise in 100-year-olds

Research undertaken at the Cicely Saunders Institute shows that over 35,000 people lived to a 100 years and over in England over the last ten years. According to this new study living beyond 100 was associated with dying from frailty exacerbated by pneumonia. With the number of centenarians set to grow, end-of-life care needs to be tailored to the increasing frailty and vulnerability to stressor events in this age group. Boosting care home capacity and planning health services for the rise in people who live beyond 100 years could help to reduce reliance on hospital admission at the end of life, and ensure a better quality of end-of-life by enabling people to remain in their usual residence with the support and care to die in comfort and dignity with loved ones nearby.

Centenarians – people aged 100 years or over - are a rapidly growing demographic group worldwide. In 2011, centenarians globally numbered over 300,000. They are projected to reach three million worldwide by 2050, and 17 million at the end of the century. In the UK, this group has steadily increased since 1956 with numbers roughly doubling every 10 years. The latest Office of National Statistics figures indicate that 13,350 centenarians were living in the UK in 2012. Over half a million are expected to be living in the UK by 2066.

Few studies have looked at the health and social care needs of centenarians compared to younger cohorts of older people, or the implications of extreme longevity for health policy and services. The King’s study, published in the journal PLoS Medicine, examined the cause and place of death in 35,867 centenarians in England between 2001 and 2010, and compared these findings with those of people who died in their 80s to 90s. The study also looked at factors such as the effect of socioeconomic deprivation on place of death.

The 35,867 people in the study spanned the age range 100-115 years (average age 101), and mainly comprised women (87%) and widowed people (85%). The number of centenarian deaths per year in England increased from 2,800 in 2001 to nearly 4,400 in 2010. Areas of highest deprivation in the UK had the lowest proportion of centenarian deaths, with dying more likely to occur in hospital than in a community setting. The North East of England had the lowest overall proportion of centenarian deaths (4%).

Over the ten-year period, around 60 per cent of centenarians died in a residential or nursing care home, a quarter died in hospital, a tenth died at home and a small number (0.2%) in a hospice. ‘Old age’ was the most common cause of certifying death (28%), followed by pneumonia (18%) and other respiratory diseases (6%); stroke (10%); heart disease (9%) and other circulatory diseases (10%); dementia and Alzheimer’s disease (6%); and cancer (4%). Pneumonia accounted for the largest group of hospital deaths, while across non-hospital settings ‘old age’ formed the largest category followed by pneumonia. Overall, three-quarters of centenarian death certificates stated ‘old age’ as either an underlying cause (28%) or contributing cause (47%).

The main causes of death changed with increasing age. In the group aged 80-85 years, heart disease was stated on 19% of death certificates, with ‘old age’ on only one per cent of certificates .

Dr Catherine Evans, Clinical Lecturer in Palliative Care at the Cicely Saunders Institute said: “Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to stressor events like pneumonia and poor health outcomes. We need to plan for health care services that meet the ‘hidden needs’ of this group of vulnerability to ‘acute’ decline associated with a stressor event, notably pneumonia. Increasing high quality care home capacity and responsive primary and community health services is required to enable people to remain in a comfortable, familiar environment in their last months of life.

“Compared to other European countries the proportion of people aged 90 years and over dying in hospital in England is high, and the number dying in care homes is low. For example, in the Netherlands and Finland more than three-quarters of people aged over 90 die in a long-term care setting such as a nursing home; far fewer die in hospital.

“Hospital admission in the last weeks of life accounts for a third of the total cost of end-of-life care per patient. Increasing the number of care home beds could reduce the reliance on hospital care, but we also need to ensure that services provided by GPs, community nurses and other healthcare workers can meet the complex health needs of those living to a very old age.”‘

Place and cause of death in centenarians: a population based observational study in England, 2001 to 2010’, by Evans et al, is published in the journal PLoS Medicine (Open Access).

Read the full paper online (open access).

This work was supported by the GUIDE_Care project funded by the National Institute for Health Research Health Services and Delivery Research(NIHR HS&DR) programme (Project number 09/2000/58). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. GUIDECare is a porject initiated by the Cicely Saunders Institute to investigate patterns in place of death and the factors that affect these patters. You can read more about the GUIDECare project here on our website.