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. 2011 Apr 13:11:228.
doi: 10.1186/1471-2458-11-228.

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

Dirk Houttekier  1 , Joachim Cohen, Johan Surkyn, Luc Deliens
Affiliations

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

Dirk Houttekier et al. BMC Public Health. .

Abstract

Background: Since 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.

Methods: Analysis 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.

Results: Hospital 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.

Conclusions: Additional 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.

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Figures

Figure 1
Figure 1
Trends in home death (aged ≥65 y) by living arrangement. P-value for χ2 for difference in trend of home death of all categories of living arrangement and the global trend of home death: p < 0.001, except for singles: p = 0.925.
Figure 2
Figure 2
Trends in hospital death (aged ≥65 y) by living arrangement. P-value for χ2 for difference in trend of hospital death of all categories of living arrangement and the global trend of hospital death: p < 0.001.
Figure 3
Figure 3
Trends in care home death (aged ≥65 y) by living arrangement. P-value for χ2 for difference in trend of care home death of all categories of living arrangement and the global trend of care home death: <0.001
Figure 4
Figure 4
Projected trends in proportion of home deaths, hospital deaths and care home deaths (2008-2040), based on 2 scenarios. Age- and sex-specific mortality projections of the Belgian National Planning Bureau were used to perform linear projections of numbers of deaths from 2008 to 2040 in all care settings starting from the age- and sex-specific proportions of deaths in the different care settings in the period 1998-2007. Two scenarios were considered. In scenario 1 (S1) future trends in place of death were projected starting from the age- and sex- specific distribution of place of death in 2007. In scenario 2 (S2) the projection was based on the age- and sex-specific percentage point change in place of death from 1998 to 2007.
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