How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery

Abstract

ObjectiveTo estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery.DesignWe estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need.SettingScotland, population of 5.4 million.ParticipantsAll decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey.Primary and secondary outcomesEstimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively.ResultsWe project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred.ConclusionsBy 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.

Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA)

“…The population is younger than the European Union average but faces the same basic demographic pressures as all high-income countries: increasing longevity, falling fertility, rising health and social care expenditures, and a growing workforce dependency ratio 23 , 24 . A younger population translates to fast-growing population health need; for example, the number of people dying with an incurable illness is projected to increase approximately 90% in Ireland over the next 30 years, compared to an increase of approximately 30% in England and Wales, and Scotland 11 , 25 , 26 .…”

Last Aid Training Online: Participants’ and Facilitators’ Perceptions from a Mixed-Methods Study in Rural Scotland

“…By 2040, the number of people with increasingly complex palliative care needs in Scotland is projected to rise by 20% [1]. A recent Scottish expert consultation identifies the need to build community capacity and resilience to support informal palliative caregiving so people can remain at home if they so wish [2].…”

Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life

“…As the population ages, the number of people who will need palliative care is projected to increase notably in the coming decades due to multimorbidity and advanced chronicity. In the United Kingdom, a 14–25% increase in palliative care needs is expected by 2040, especially in patients with diseases such as dementia and cancer ( 1 , 2 ). The complexity of care for older people, who have heterogeneous profiles and diverse needs, values, preferences, and therapeutic objectives, is increasing ( 3 ).…”