Predictors of place of death in South West Scotland 2000-2010: Retrospective cohort study

Abstract

Background: Surveys suggest most people would prefer to die in their own home.

Aim: To examine predictors of place of death over an 11-year period between 2000 and 2010 in Dumfries and Galloway, south west Scotland.

Design: Retrospective cohort study.

Setting/participants: 19,697 Dumfries and Galloway residents who died in the region or elsewhere in Scotland. We explored the relation between age, gender, cause of death (cancer, respiratory, ischaemic heart disease, stroke and dementia) and place of death (acute hospital, cottage hospital, residential care and home) using regression models to show differences and trends. The main acute hospital in the region had a specialist palliative care unit.

Results: Fewer people died in their own homes (23.2% vs 29.6%) in 2010 than in 2000. Between 2007 and 2010, men were more likely to die at home than women (p < 0.001), while both sexes were less likely to die at home as they became older (p < 0.001) and in successive calendar years (p < 0.003). Older people with dementia as the cause of death were particularly unlikely to die in an acute hospital and very likely to die in a residential home (p < 0.001). Between 2007 and 2010, an increasing proportion of acute hospital deaths occurred in the specialist palliative care unit (6% vs 11% of all deaths in the study).

Conclusion: The proportion of people dying at home fell during our survey. Place of death was strongly associated with age, calendar year and cause of death. A mismatch remains between stated preference for place of death and where death occurs.

Keywords: Place of death; acute hospital; advance care planning; cause of death; cottage hospital; death; dementia; home; hospice; hospice care; palliative care; patient preference; residential care.

Figure 1.

Likelihood of dying in each of four locations of death by age and gender between 2000 and 2010, as fitted in binary regression model. Men and women were progressively less likely to die at home or in an acute hospital and more likely to die in a cottage hospital or residential care as they became older.

Figure 2.

Likelihood of dying at home by age, gender and year of death registration between 2007 and 2010, as fitted in binary regression model. In 2010, the effect of age was ‘steeper’ than in 2007, that is, the probability of dying at home decreased progressively as people became older than in 2007.

Figure 3.

(a) Likelihood of dying in an acute or cottage hospital by age and cause of death between 2007 and 2010, as fitted in multinomial regression model. Those with dementia as cause of death were particularly unlikely to die in an acute hospital as they aged. (b) Likelihood of dying at home or in residential care by age and cause of death between 2007 and 2010, as fitted in multinomial regression model. People were less likely to die at home as they aged. Those with dementia very likely to die in a residential home as they aged.