title: International variation in place of death of older people who died from dementia in 14 European and non-European countries.
abstract: OBJECTIVE
  The objective of this study was to examine variation in place of death of older people dying from dementia in countries across 4 continents.
  
  
  METHODS
  Study of death certificate data.
  
  
  METHODS
  We included deaths of older (65 + years) people whose underlying cause of death was a dementia-related disease (ICD-10: F01, F02, F03, G30) in Belgium, the Netherlands, England, Wales, France, Italy, Spain, Czech Republic, Hungary, New Zealand, United States, Canada, Mexico and South Korea. We examined associations between place of death and sociodemographic factors, social support, and residential and health care system factors.
  
  
  RESULTS
  Overall, 4.8% of all deaths were from a dementia-related disease, ranging from 0.4% in Mexico to 6.9% in Canada. Of those deaths, the proportion occurring in hospital varied from 1.6% in the Netherlands to 73.6% in South Korea. When controlling for potential confounders, hospital death was more likely for men, those younger than 80, and those married or living in a region with a higher availability of long-term care beds, although this could not be concluded for each country. Hospital death was least likely in the Netherlands compared with other countries.
  
  
  CONCLUSIONS
  Place of death of older people who died from a dementia-related disease differs substantially between countries, which might point to organizational differences in end-of-life care provision. Increasing the availability of long-term care beds might be important to reduce the number of hospital deaths, while focusing specialized end-of-life care services on married people or those aged 65 to 79 might be crucial for achieving home death. However, proper end-of-life care needs to be ensured in hospitals, should this be the most appropriate end-of-life care setting.
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium. Electronic address: Thijs.reyniers@vub.ac.be.
authors.forename: Thijs
authors.initials: T
authors.lastname: Reyniers
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H Roeline
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; French National Observatory on End-of-Life Care, Paris, France.
authors.forename: Lucas
authors.initials: L
authors.lastname: Morin
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Addington-Hall
authors.affiliation: National Institute of Statistics, Rome, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Frova
authors.affiliation: MD Anderson Cancer Center Department of Leukemia, University of Texas, Houston, TX.
authors.forename: Marylou
authors.initials: M
authors.lastname: Cardenas-Turanzas
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bregje
authors.initials: B
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Hospice Waikato, Hillcrest, Hamilton, New Zealand.
authors.forename: Wayne
authors.initials: W
authors.lastname: Naylor
authors.affiliation: Department of Information and Evaluation, Regional Ministry of Equality, Health and Social Policies in Andalusia, Seville, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Ramos
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Wilson
authors.affiliation: Center for Palliative Care, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Loucka
authors.affiliation: University of Pécs Medical School, Pécs, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Csikos
authors.affiliation: Department of Health Sciences, Dongduk Women's University, Seoul, South Korea.
authors.forename: Yong Joo
authors.initials: YJ
authors.lastname: Rhee
authors.affiliation: Brown University, School of Public Health, Providence, RI.
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016001:Confidence Intervals; D016208:Databases, Factual; D003644:Death Certificates; D003704:Dementia / Q000175:diagnosis / Q000401:mortality*; D005060:Europe; D005260:Female; D005843:Geography; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D038622:Internationality; D007723:Korea; D016015:Logistic Models; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D009520:New Zealand; D009735:Nursing Homes / Q000706:statistics & numerical data / Q000600:supply & distribution*; D016017:Odds Ratio; D012720:Severity of Illness Index; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Place of death; death certificates; dementia; end-of-life care