Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes

Abstract

BackgroundSince most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study aims to examine past trends and future projections of place of death.MethodsAnalysis of death certificates (decedents aged ≥ 1 year) in Belgium (Flanders and Brussels Capital region) 1998-2007. Trends in place of death were adjusted for cause of death, sociodemographic characteristics, environmental factors, numbers of hospital beds, and residential and skilled nursing beds in care homes. Future trends were based on age- and sex-specific mortality prognoses.ResultsHospital deaths decreased from 55.1% to 51.7% and care home deaths rose from 18.3% to 22.6%. The percentage of home deaths remained stable. The odds of dying in a care home versus hospital increased steadily and was 1.65 (95%CI:1.53-1.78) in 2007 compared to 1998. This increase could be attributed to the replacement of residential beds by skilled nursing beds. Continuation of these trends would result in the more than doubling of deaths in care homes and a decrease in deaths at home and in hospital by 2040.ConclusionsAdditional end-of-life care resources in care homes largely explain the decrease in hospital deaths. Care homes will become the main locus of end-of-life care in the future. Governments should provide sufficient skilled nursing resources in care homes to fulfil the end-of-life care preferences and needs of patients.

End-of-life care bonus promoting end-of-life care in nursing homes: An 11-year retrospective longitudinal prefecture-wide study in Japan

“…In the present study, only the presence of an adjacent affiliated hospital was consistent with the findings of previous studies (15,16,25,26). These studies showed that facility determinants of dying in nursing homes were the existence of a basic policy for EOL care, a physician based in a home care supporting clinic, location in a rural region, being adjacent to an affiliated hospital, being government-owned, location in regions with more nursing home beds, and location in regions with fewer hospital beds.…”

The Preferred Place of Last Days: Results of a Representative Population-Based Public Survey

“…1,34 Nursing home deaths are likely to increase with population aging and with more people reaching very old ages. 34 Despite the need for qualitative and other research to establish why widowhood is a major place predictor and why most people chose the home over other places for their final days, the widespread home preference indicates public health interventions are needed to promote good home deaths.…”

“…1 Not only does the place of death or end-of-life (EOL) care impact the quality of death and dying, 2 but there are many direct and indirect costs and other considerations associated with the place of death and dying. 3 Although much has been made of the high cost of dying in hospitals and nursing homes, 4 home-based dying often involves significant out-of-pocket costs in addition to difficult tasks and responsibilities for family caregivers.…”

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

“…In some countries such as Japan and Belgium, a large share of deaths still occur in hospitals, while in the USA and Canada, death at home or in nursing homes is tending to replace death in hospital [3–7]. …”