Ahmad S, O'Mahony M S
University Department of Geriatric Medicine, Academic Centre, Llandough Hospital, Penarth, UK.
QJM. 2005 Dec;98(12):865-70. doi: 10.1093/qjmed/hci138.
Palliative medicine services have invested in the community to support people dying at home. To develop end-of-life care for older people, we need to know where they die.
To examine trends in age and location of death over the last 20 years.
Retrospective death certificate review.
All Wales death certificates from 1981 to 2001 were examined. Place of death and age were noted.
Total deaths decreased from 35,015 in 1981 to 32,966 in 2001, and mortality decreased from 12.45 per 1000 population in 1981 to 11.33 in 2001. Deaths in the community decreased from 37.6% (n = 13,155) to 22.1% (n = 7293) (p < 0.001); deaths increased in hospital from 56.7% (n = 19,871) to 61.7% (n = 20,334) (p < 0.001) and in care homes from 5.7% (n = 1989) to 16.2% (n = 5339) (p < 0.001). Between 1981 and 2001, deaths in those aged 65-74 years dropped from 9752 to 6361, but increased in the over-85s from 5661 to 9779. Deaths amongst 75-84-year-olds remained stable at around 11,000. The biggest rise in hospital and care-home deaths was in those over 85: hospital deaths increased from 2928 in 1981, to 5438 in 2001; care-home deaths increased from 941 to 3141.
The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. End-of-life needs for older people need to be addressed in hospital and care homes, not just in the community.
姑息医学服务机构已在社区投入资源，以支持在家中离世的人们。为了发展针对老年人的临终关怀，我们需要了解他们的死亡地点。
研究过去20年中死亡年龄和死亡地点的趋势。
回顾性死亡证明审查。
检查了1981年至2001年全威尔士的死亡证明。记录了死亡地点和年龄。
总死亡人数从1981年的35,015人降至2001年的32,966人，死亡率从1981年的每1000人口12.45人降至2001年的11.33人。社区死亡人数从37.6%（n = 13,155）降至22.1%（n = 7293）（p < 0.001）；医院死亡人数从56.7%（n = 19,871）增至61.7%（n = 20,334）（p < 0.001），养老院死亡人数从5.7%（n = 1989）增至16.2%（n = 5339）（p < 0.001）。1981年至2001年期间，65 - 74岁人群的死亡人数从9752人降至6361人，但85岁以上人群的死亡人数从5661人增至9779人。75 - 84岁人群的死亡人数稳定在11,000人左右。医院和养老院死亡人数增长最多的是85岁以上人群：医院死亡人数从1981年的2928人增至2001年的5438人；养老院死亡人数从941人增至3141人。
在过去20年中，死亡地点发生了显著变化，从社区转移到了医院和养老院。85岁以上人群在医院和养老院的死亡人数增长最多。老年人的临终需求需要在医院和养老院得到满足，而不仅仅是在社区。
