1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Palliat Med. 2018 Feb;32(2):329-336. doi: 10.1177/0269216317734435. Epub 2017 Oct 10.
Population ageing represents a global challenge for future end-of-life care. Given new trends in place of death, it is vital to examine where the rising number of deaths will occur in future years and implications for health and social care.
To project where people will die from 2015 to 2040 across all care settings in England and Wales.
Population-based trend analysis and projections using simple linear modelling. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and 'other' were applied to numbers of expected future deaths. Setting/population: All deaths (2004-2014) from death registration data and predicted deaths (2015-2040) from official population forecasts in England and Wales.
Annual deaths are projected to increase from 501,424 in 2014 (38.8% aged 85 years and over) to 635,814 in 2040 (53.6% aged 85 years and over). Between 2004 and 2014, proportions of home and care home deaths increased (18.3%-22.9% and 16.7%- 21.2%) while hospital deaths declined (57.9%-48.1%). If current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023.
To sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.
人口老龄化是未来临终关怀面临的全球性挑战。鉴于死亡地点的新趋势，研究未来几年死亡人数将在何处增加以及对卫生和社会保健的影响至关重要。
预测英格兰和威尔士所有护理环境中 2015 年至 2040 年的死亡地点。
使用简单线性建模进行基于人群的趋势分析和预测。将医院、护理院、家庭、临终关怀院和“其他”中按年龄和性别划分的死亡比例应用于预期未来死亡人数。
地点/人群：来自英格兰和威尔士死亡登记数据的所有死亡人数（2004-2014 年）和官方人口预测的预计死亡人数（2015-2040 年）。
预计每年的死亡人数将从 2014 年的 501,424 人（85 岁及以上人口占 38.8%）增加到 2040 年的 635,814 人（85 岁及以上人口占 53.6%）。2004 年至 2014 年期间，家庭和护理院死亡比例增加（18.3%-22.9%和 16.7%-21.2%），而医院死亡人数下降（57.9%-48.1%）。如果当前趋势继续下去，护理院和家庭中的死亡人数将分别增加 108.1%和 88.6%，到 2040 年，护理院将成为最常见的死亡地点。如果护理院的容量没有扩大，并且医院中增加了额外的死亡人数，那么到 2023 年，医院的死亡人数将开始上升。
要维持当前的趋势，到 2040 年，护理院和社区的临终关怀服务需要增加一倍。迫切需要在整个护理环境中建立一个支持不断增加的年度死亡人数的基础设施；否则，医院的死亡人数将会增加。
