End of life care / National Audit Office.

  • Great Britain. National Audit Office.
Date:
[2008], ©2008
Catalogue details

Licence: Open Government Licence

Credit: End of life care / National Audit Office. Source: Wellcome Collection.

    17/64 (page 15)
    2.4 In 2006, 58 per cent of all deaths in England occurred in a hospital, ranging from 46 per cent to 77 per cent across PCTs. Many people are admitted to hospital for emergency treatment or symptom management and, for some people, hospitals remain their preferred place of care. Our analysis of mortality statistics in PCTs shows that the incidence of home deaths is not strongly related to the level of deprivation, a factor which is commonly thought to inhibit choosing to die at home. Type of illness does, however, influence the setting where people are likely to die. For example, 94 per cent of all hospice deaths are patients with cancer and over half of deaths from dementia occur in care homes (Figure 4). 2.5 Variation in place of death can partly be explained by the way different diseases progress (Figure 5). For cancer, the disease trajectory is relatively predictable, with patients tending to experience a period of relatively rapid decline at the end of life, whilst dementia has a more gradual deterioration. For other conditions, the trajectory is less predictable. For example, people with chronic obstructive pulmonary disease experience sudden dips in their health leading to emergency admissions, followed by a period of relative stability, whilst motor neurone disease (MND) can progress rapidly from diagnosis to death (Appendix 6, Example 1). In the less predictable cases it is more difficult to identify when death is likely to occur and when end of life care should begin, leading to an increased incidence of deaths in hospital. ‘Place of death varies by condition eo _ Percentage 0 SO tea IT a EY 40 30 20 10 EGER ELIE TE EEC LO TIER: 0 ROR SeeS press Heart Failure Cancer Dementia Condition DEED E TERE POE MH Care Home Home HB Hospital —B Hospice Source: National Audit Office analysis of 2006 Mortality Statistics for England ie Chronic, progressive, and eventually fatal illnesses typically follow three trajectories Function High Mostly cancer Low Time —-=-————— > Short period of evident decline High Mostly heart and lung failure Low rs Long-term limitations with intermittent serious episodes Time High Mostly frailty and dementia Low Time Source: lynn and Adamson (2003) Living Well at the End of Life: Adapting Health Care to Serious Chronic Illness in Old Age