title: Reversal of English trend towards hospital death in dementia: a population-based study of place of death and associated individual and regional factors, 2001-2010.
abstract: BACKGROUND
  England has one of the highest rates of hospital death in dementia in Europe. How this has changed over time is unknown. This study aimed to analyse temporal trends in place of death in dementia over a recent ten year period.
  
  
  METHODS
  Population-based study linking Office for National Statistics mortality data with regional variables, in England 2001-2010. Participants were adults aged over 60 with a death certificate mention of dementia. Multivariable Poisson regression was used to determine the proportion ratio (PR) for death in care home (1) and home/hospice (1) compared to hospital (0). Explanatory variables included individual factors (age, gender, marital status, underlying cause of death), and regional variables derived at area level (deprivation, care home bed provision, urbanisation).
  
  
  RESULTS
  388,899 deaths were included. Most people died in care homes (55.3%) or hospitals (39.6%). A pattern of increasing hospital deaths reversed in 2006, with a subsequent decrease in hospital deaths (-0.93% per year, 95% CI -1.08 to -0.79 p < 0.001), and an increase in care home deaths (0.60% per year, 95% CI 0.45 to 0.75 p < 0.001). Care home death was more likely with older age (PR 1.11, 1.10 to 1.13), and in areas with greater care home bed provision (PR 1.82, 1.79 to 1.85) and affluence (PR 1.29, 1.26 to 1.31). Few patients died at home (4.8%) or hospice (0.3%). Home/hospice death was more likely in affluent areas (PR 1.23, 1.18 to 1.29), for women (PR 1.61, 1.56 to 1.65), and for those with cancer as underlying cause of death (PR 1.84, 1.77 to 1.91), and less likely in the unmarried (PRs 0.51 to 0.66).
  
  
  CONCLUSIONS
  Two in five people with dementia die in hospital. However, the trend towards increasing hospital deaths has reversed, and care home bed provision is key to sustain this. Home and hospice deaths are rare. Initiatives which aim to support the end of life preferences for people with dementia should be investigated.
authors.affiliation: Department of Palliative Care Policy & Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, London SE5 9PJ, UK. Katherine.sleeman@kcl.ac.uk.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Sleeman
authors.forename: Yuen K
authors.initials: YK
authors.lastname: Ho
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D006699:Home Care Services / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000639:trends*; D011159:Population Surveillance / Q000379:methods; D013727:Terminal Care / Q000379:methods / Q000639:trends