The study, funded by the National Institute for Health Research HS&DR Programme (09/2000/58) through the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) and published in the journal Palliative Medicine, examined all hospice deaths in England over a 20-year period, including almost 450,000 deaths from 1993-2012. The study investigated how trends in hospice deaths have changed over time. It also examined the relationship between dying in a hospice and factors such as age, diagnosis and socio-economic position.
The UK hospice system is the most developed in the world, with 223 adult inpatient hospice units in England. Around half of all admissions to these hospices are for end-of-life care, with the remainder being for symptom control or respite. In addition to offering inpatient care, many hospices also provide community services and day care. This is the first study to use whole-population data to examine how hospice deaths have changed over time, and the factors related to hospice death.
The study found a steady increase in the annual number of hospice deaths from 17,400 in 1993 to 26,000 in 2012. This accounted for 3.4% of all deaths in England in 1993, and 6.0% in 2012.
Most of those who died were married (55%) or widowed (26%), half were men, and the average age of death was 70. The vast majority died from cancer, with just 5% of all deaths occurring in people with non-cancer diagnoses, although this proportion increased from 3.9% to 7.7% over the study period.
The study also found that people who died in hospice were more likely to be resident in affluent than deprived areas, and that this gap grew by 25% over the study period.
Dr Katherine Sleeman, first author from the Cicely Saunders Institute at King’s College London, says:
‘For over 40 years hospices in England have played an important role in end-of-life care, particularly for people with cancer. However, the demographics of death are changing, and people are dying at older ages, and increasingly from chronic conditions with long periods of decline.
‘The annual number of UK deaths is predicted to rise, and policy makers and practitioners need to consider whether the current models of hospice care are best suited to the changing needs of an ageing society.
‘It is concerning that trends suggest that when it comes to death in hospice, the gap between rich and poor is increasing. We must ensure that access to specialist hospice care is available to everyone.’
Notes to editors
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‘The changing demographics of inpatient hospice death. Population based cross-sectional study in England 1993-2012’ by Sleeman et al is published in the journal Palliative Medicine on 20 May 2015.
This paper summaries independent research funded by the National Institute for Health Research (NIHR) through the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, part of the NIHR and a partnership between King’s Health Partners, St. George’s, University London, and St George’s Healthcare NHS Trust.
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The National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR Programme is funded by the NIHR with specific contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. www.nets.nihr.ac.uk/programmes/hsdr
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).
This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.