Demographic, Health, and Social Predictors of Place of Death in England, 2004-2013: Identifying barriers to dying in the community.

Abstract

The reduction of hospital deaths is a policy priority in most developed countries. However, health and social care systems experience difficulties in delivering this outcome. Moreover, studies of place of death fail to identify barriers to dying in the community. To address this gap, this study estimates the unique effects of disease diagnosis and care provider type on the probability that ill adults aged 50 and older die in a private home, care home, hospital, or hospice. It does so by applying multinomial logistic regression analysis to data from the English Longitudinal Study of Ageing. Crucially, the analysis controls for sociodemographic factors, disability, and prognostic uncertainty by accounting for whether relatives anticipated the death. Cancer predicts hospice death, while non-cancer diagnosis and care provision by a partner predict hospital death. Dementia is a barrier to dying in a private home, while it is associated with a care home death. This suggests that community palliative care referral pathways cater to cancer diagnoses, while private home-based palliative care services struggle to support adults with dementia to die at home, regardless of prognostic accuracy. Including cancer-free adults in community palliative care referral pathways, and supporting their partners in care provision, would likely reduce hospital deaths.