Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world

Abstract

Background: Monitoring where people die is key to ensure that palliative care is provided in a responsive and integrated way.

Aim: To examine trends of place of death and project hospital deaths until 2030 in an ageing country without integrated palliative care.

Design: Population-based observational study of mortality with past trends analysis of place of death by gender, age and cause of death. Hospital deaths were projected until 2030, applying three scenarios modelled on 5-year trends (2006-2010).

Setting/participants: All adult deaths (⩾18 years old) that occurred in Portuguese territory from 1988 to 2010.

Results: There were 2,364,932 deceased adults in Portugal from 1988 to 2010. Annual numbers of deaths increased 11.1%, from 95,154 in 1988 to 105,691, mainly due to more than doubling deaths from people aged 85+ years. Hospital deaths increased by a mean of 0.8% per year, from 44.7% (n = 42,571) in 1988 to 61.7% (n = 65,221) in 2010. This rise was largest for those aged 85+ years (27.8% to 54.0%). Regardless of the scenario considered, and if current trends continue, hospital deaths will increase by more than a quarter until 2030 (minimum 27.7%, maximum 52.1% rise) to at least 83,293 annual hospital deaths, mainly due to the increase in hospital deaths in those aged 85+ years.

Conclusion: In one of the most ageing countries in the world, there is a long standing trend towards hospitalised dying, more pronounced among the oldest old. To meet people's preferences for dying at home, the development of integrated specialist home palliative care teams is needed.

Keywords: Palliative care; aged; death certificates; health planning; home care services; terminal care.

Figure 1.

Past trends and future projections of total numbers of births and deaths (Portugal, 1890–2060), deceased and resident population pyramids (Portugal, 1988, 2010, 2030). Data source for past deaths, births and resident numbers (1890–2010) – INE; data source for future deaths, births and resident numbers (2011–2060) – Eurostat; deceased age pyramids only include deaths at ages of 18+ years. Left bars (blue) in the age pyramids refer to men and right bars (red) refer to women.

Figure 2.

Past trends of deaths by place of death and proportion of hospital deaths by age group (Portugal, 1988–2010). st: age- and gender-standardised proportion; the age groups presented represent more than 90% of all deaths in the study in recent years.

Figure 3.

Past trends and future projections of hospital deaths according to three models (Portugal, 1988–2030). The mean of the last 5-year slopes (2006–2010) was used in all models. The slopes’ variable changed depending on the model: model 1 – slopes of absolute numbers of hospital deaths; model 2 – slopes of proportion of change of hospital deaths; and model 3 – slopes of proportions of non-hospital deaths.