New study reveals one of the fastest hospitalised dying trends known
A new population-based study on place of death was published in the journal Palliative Medicine1. CSI researchers Vera Sarmento, Irene Higginson and Barbara Gomes examined past trends in place of death by age, gender and cause of death and projected future hospital deaths until 2030 in Portugal, a country without integrated palliative care. The study was funded by the Calouste Gulbenkian Foundation as part of the DINAMO project.
With 24 % of people aged 60+ years, Portugal is at the forefront of global ageing. As this proportion is expected to rise up to 40% by 2050, this 10 million-population country will become the second most ageing country in the world, after Japan2.
The findings show one of the fastest hospitalised dying trends known, opposite to trends in England, Canada, the US and Belgium, in the same direction as Greece and Japan but faster. The proportion of people dying in hospitals in Portugal is rising since 1988, from less than half to almost two thirds, with a shooting rise for the aged 85+ years (28% to 54% in 2010).
Following world trends, the annual number of deaths is predicted to rise; in this context, if nothing is done and the current trends continue, 3 in 4 will die in hospital by 2030. The number of hospital deaths of people aged 85+ would double. This is not sustainable and goes against what the majority of people prefer, which is to die at home3.
Previous research from the Cicely Saunders Institute4,5 suggests that with targeted national strategies focused on developing palliative care support in the community it is possible to influence hospitalised dying trends and enable more people to die at home; this aligns with the recent WHO resolution6 that urges countries to develop integrated models of palliative care, mainly focused in primary care, community and home care services.
Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world by Sarmento et al was published in the journal Palliative Medicine on 10 July 2015.
1 Sarmento V, Higginson IJ, Ferreira PL, Gomes B. Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world. Palliat Med July 10, 2015 doi:10.1177/0269216315594974
2 Department of Economic and Social Affairs. Population ageing and development 2012 (Wall Chart). New York: United Nations, 2012.
3 Gomes B, Higginson IJ, Calanzani N, et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol 2012; 23: 2006–2015.
4 Gomes B, Calanzani N, Curiale V, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2013; 6: CD007760.
5 Gomes B, Calanzani N, Higginson IJ. Reversal of the British trends in place of death: time series analysis 2004–2010. Palliat Med 2012; 26: 102–107.
6 World Health Organization Executive Board. Strengthening of palliative care as a component of integrated treatment within the continuum of care. Resolution EB134.R7, 23 January 2014. Geneva: WHO Executive Board.