Population-based palliative care planning in Ireland: how many people will live and die with serious illness to 2046?

Abstract

Background: All countries face growing demand for palliative care services.  Projections of need are essential to plan care in an era of demographic change.   We aim to estimate palliative care needs in the Republic of Ireland from 2016 to 2046. Methods: Static modelling of secondary data.  First, we estimate the numbers of people who will die from a disease associated with palliative care need.  We combine government statistics on cause of death (2007-2015) and projected mortality (2016-2046).  Second, we combine these statistics with survey data to estimate numbers of people aged 50+ living and dying with diseases associated with palliative care need.  Third, we use these projections and survey data to estimate disability burden, pain prevalence and health care utilisation among people aged 50+ living and dying with serious medical illness. Results: In 2016, the number of people dying annually from a disease indicating palliative care need was estimated as 22,806, and the number of people not in the last year of life aged 50+ with a relevant diagnosis was estimated as 290,185.  Equivalent estimates for 2046 are up to 40,355 and 548,105, increases of 84% and 89% respectively.  These groups account disproportionately for disability burden, pain prevalence and health care use among older people, meaning that population health burdens and health care use will increase significantly in the next three decades. Conclusion: The global population is ageing, although significant differences in intensity of ageing can be seen between countries. Prevalence of palliative care need will nearly double over 30 years, reflecting Ireland’s relatively young population.  Older people living with a serious disease outnumber those in the last year of life by approximately 12:1, necessitating implementation of integrated palliative care across the disease trajectory. Urgent steps on funding, workforce development and service provision are required to address these challenges.