The number of people dying at home in England and Wales has nearly halved in three decades, and now less than a fifth of people die at home.
By 2030, if this trend continues, fewer than one in 10 men and women will die at home, a new study has calculated (Palliative Medicine 2008;22:33-41).
To cope with such a decline, inpatient facilities will need to increase by more than 20%, say the researchers, from King’s College London.
“The projections underline the urgent need for planning end of life care to accommodate a large increase of ageing and deaths,” said Barbara Gomes, one of the coauthors. “Either inpatient facilities must increase substantially, or many more people will need community end of life care from 2012 onwards.”
The authors analysed trends in the place of death from 1974 to 2003 in England and Wales and then projected the likely trend to 2030.
From 1974 to 2003 a total of 17 million people died in England and Wales, and the percentage of all deaths that were due to cancer rose from 21% to 26%. Over the same period the number of people dying at the age of 85 or over doubled.
Over the period four million died in their homes (24% of all deaths), about 140 000 a year on average. The percentage of deaths that occurred at home fell from 31% in 1974 to 18% in 2003, and the decline was greatest among people who did not die from cancer, women, and older age groups. In the last year of data almost 90% of people who died at the age of 85 or over died in an institution.
From 1999 to 2003 the proportion of deaths at home fell by 1.3%, while the proportion of deaths in NHS hospitals rose from 54% to 58%.
The author’s projections, taking into account changes in age and sex distribution, show that if the trend seen in the past five years continues the number of deaths at home will fall by 42% and that less than 10% of people will die at home in 2030.
The projections also show that the annual number of deaths in institutions will increase by 20% by 2030.
“In England and Wales the trend up until 2003 has been for decreasing numbers and proportions of deaths at home, especially among older people. A reversal of this trend will be an enormous task,” said Irene Higginson, head of the Department of Palliative Care, Policy and Rehabilitation at King’s College London and the study’s other coauthor.
“The projections indicate a dramatic rise of total numbers of deaths from 2012 onwards, largely because of the increasing ageing of the population. Either there will be a substantial increase in institutional deaths or major rises in numbers needing community end of life care. Whatever the future scenario, major changes need to occur in the provision of care towards the end of life. Planning for this should start soon.”
The authors wrote, “The next five years will be crucial for the development of incremental plans to expand structures of care at the right place, able to meet the increase in demand, the future needs of older people and ensure quality end of life care at home, in hospitals, nursing homes and hospices.”