The impact of population ageing on end-of-life care in Scotland: projections of place of death and recommendations for future service provision

Abstract

Abstract Background Global annual deaths are rising. It is essential to examine where future deaths may occur to facilitate decisions regarding future service provision and resource allocation. Aims To project where people will die from 2017 to 2040 in an ageing country with advanced integrated palliative care, and to prioritise recommendations based on these trends. Methods Population-based trend analysis of place of death for people that died in Scotland (2004–2016) and projections using simple linear modelling (2017–2040); Transparent Expert Consultation to prioritise recommendations in response to projections. Results Deaths are projected to increase by 15.9% from 56,728 in 2016 (32.8% aged 85+ years) to 65,757 deaths in 2040 (45% aged 85+ years). Between 2004 and 2016, proportions of home and care home deaths increased (19.8–23.4% and 14.5–18.8%), while the proportion of hospital deaths declined (58.0–50.1%). If current trends continue, the numbers of deaths at home and in care homes will increase, and two-thirds will die outside hospital by 2040. To sustain current trends, priorities include: 1) to increase and upskill a community health and social care workforce through education, training and valuing of care work; 2) to build community care capacity through informal carer support and community engagement; 3) to stimulate a realistic public debate on death, dying and sustainable funding. Conclusion To sustain current trends, health and social care provision in the community needs to grow to support nearly 60% more people at the end-of-life by 2040; otherwise hospital deaths will increase.