title: Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes.
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.
authors.affiliation: Vrije Universiteit Brussel, End-of-Life Care Research Group Ghent University & Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium. dirk.houttekier@vub.ac.be
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Johan
authors.initials: J
authors.lastname: Surkyn
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003643:Death; D003644:Death Certificates; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000639:trends*; D055815:Young Adult