Changes in life and care in the year before death 1969-1987.

Studies based on random samples of adult deaths in 1969 and 1987 show that, although more people in the recent study were living alone in the year before they die (32 per cent compared with 15 per cent in the earlier study), there had also been an increase in the proportions living in institutions and being admitted to hospital in the 12 months before their death. More of those dying in 1987 than in 1969 had had a home help, whereas the proportion receiving care from district nurses was similar for the two studies and the amount of home visiting by general practitioners had fallen. A higher proportion of those dying of cancer in 1987 than in 1969 were thought to have known that they were dying (44 per cent against 16 per cent) and that they had cancer (73 per cent compared with 29 per cent). However, the proportion of relatives and others who thought the dying person's awareness, or lack of awareness, of the prognosis was 'best as it was' was lower for people dying of cancer in the more recent study (57 per cent against 69 per cent). The symptoms reported for those dying in 1969 and 1987 were generally similar but more of those who died in 1987 had suffered from mental confusion, depression and incontinence for a year or more. This reflects the increased age at which people were dying in the later study: longer life was sometimes associated with the prolongation of unpleasant symptoms.