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Observational Study
. 2018 May 24;17(1):80.
doi: 10.1186/s12904-018-0334-0.

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

Burkhard Dasch  1 , Claudia Bausewein  2 , Berend Feddersen  2
Affiliations
Observational Study

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

Burkhard Dasch et al. BMC Palliat Care. .

Abstract

Background: Due to increasing life expectancy, more and more older people are suffering from dementia and comorbidities. To date, little information is available on place of death for dementia patients in Germany. In addition, the association of place of death and comorbidities is unknown.

Methods: A population-based cross-sectional survey was conducted in Westphalia-Lippe (Germany), based on the analysis of death certificates from 2011. Individuals with dementia ≥ 65 years were identified using the documented cause of death. In this context, all mentioned causes of death were included. In addition, ten selected comorbidities were also analyzed. The results were presented descriptively. Using multivariate logistic regression, place of death was analyzed for any association with comorbidities.

Results: A total of 10,364 death certificates were analyzed. Dementia was recorded in 1646 cases (15.9%; mean age 86.3 ± 6.9 years; 67.3% women). On average, 1.5 ± 1.0 selected comorbidities were present. Places of death were distributed as follows: home (19.9%), hospital (28.7%), palliative care unit (0.4%), nursing home (49.5%), hospice (0.9%), no details (0.7%). The death certificates documented cardiac failure in 43.6% of cases, pneumonia in 25.2%, and malignant tumour in 13.4%. An increased likelihood of dying in hospital compared to home or nursing home, respectively, was found for the following comorbidities (OR [95%-CI]): pneumonia (2.96 [2.01-4.35], p = 0.001); (2.38 [1.75-3.25], p = 0.001); renal failure (1.93 [1.26-2.97], p = 0.003); (1.65 [1.18-2.32], p = 0.003); and sepsis (13.73 [4.88-38.63], p = 0.001); (7.34 [4.21-12.78], p = 0.001).

Conclusion: The most common place of death in patients with dementia is the retirement or nursing home, followed by hospital and home. Specific comorbidities, such as pneumonia or sepsis, correlated with an increased probability of dying in hospital.

Keywords: Comorbidities; Death certificate; Dementia; End-of-life care; Observational study; Place of death.

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Conflict of interest statement

Ethics approval and consent to participate

The study was submitted to the Ethics Committee of the Ruhr University of Bochum (Germany) and approved after examination (registry no. 4522-12). The dataset was anonymized prior to analysis.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Prevalence of persons aged 65 or over with a death certificate recording dementia
Fig. 2
Fig. 2
Specific comorbid conditions in persons aged 65 or over with dementia, stratified by place of death
Fig. 3
Fig. 3
Place of death in persons aged 65 or over with dementia, stratified by gender
See this image and copyright information in PMC

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