June 4, 2014
Place And Cause Of Death In Centenarians: A Population-Based Observational Study In England
Centenarians are more likely to die of pneumonia and frailty or "old age" and less likely to die of the chronic conditions often associated with old age, such as cancer or ischemic heart disease, compared with older adults younger than 100 years, according to a study by Catherine Evans and colleagues from King's College London, London, UK. Centenarians were most likely to die in a care home (61%) or hospital (27%) and less likely to die at home (10%) or in hospice care (0.2%). Higher care bed capacity was associated with fewer deaths of centenarians in hospital.The authors linked Office for National Statistics death registration data for England 2001-2010 with area level data on deprivation (a measure of socioeconomic status of the region), settlement type place of residence, and care home bed capacity. They state that people aged 100 years or over are a rapidly growing demographic group worldwide, projected to reach 3,224,000 by 2050. Furthermore, in the UK, the number of centenarians has doubled every 10 years since 1956 and is estimated to reach over half a million by 2066. Despite these increases their health and social care needs are rarely considered in studies of older adults.
The number of centenarian deaths per year in England increased by 56% in 10 years from 2,823 in 2001 to 4,393 in 2010. The 10-year study included 35,867 people with a median age of 101 years at time of death, of whom 87% were women. The proportion dying in hospital changed little over time despite the increased numbers of centenarians, that most older people would prefer to die in their usual residence (e.g. at home or in a care home) and hospital admission in the last weeks of life is a major driver of healthcare costs at the end of life.
The authors state, "The rising number of centenarians and continued use of hospital care at the end of life indicates an urgent need to ensure adequate long-term care and responsive community care services to support people living with extreme longevity in these care settings. Compared to place of death for people aged 90 years or over in other European countries, the proportion dying in hospital in England is high and those dying in care homes low…The increasing number of care home beds is positively associated with less likely death in hospital, but this alone is insufficient to explain the marked differences in place of death by age across European countries. Variations in health care service provision to care homes by country likely contribute to differences observed...Better health care provision could enable people to remain in their usual residence and reduce hospital admission at the end of life—a major cost driver in end of life care."
They conclude, "To reduce reliance on hospital care at the end of life requires recognition of centenarians' increased likelihood to ''acute'' decline, notably from pneumonia, and wider provision of anticipatory care to enable people to remain in their usual residence, and increasing care home bed capacity."