Dying places and the COVID-19 effect
Pandemics affect death patterns worldwide, including place of death. Based on research conducted as part of the EU-funded EOLinPLACE project, COVID-19 is no exception. As described in the study published in the journal ‘eClinicalMedicine’, the percentage of people dying at home rose in 23 countries during the COVID-19 pandemic. Insight from the study could help inform public health policies with the aim of improving the quality of end-of-life care. The research team examined trends in place of death for adults in 32 countries worldwide: Austria, Belgium, Brazil, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Mexico, the Netherlands, Poland, Portugal, Republic of Korea, Romania, Slovakia, Slovenia, Spain, Sweden, Uganda, the United Kingdom and the United States of America. Comparisons were made between the initial COVID-19 pandemic years (2020-2021) and the 8 years before the pandemic (2012-2019). The study included 100.7 million people aged 18 years and over, 68 % of whom were 70 or older. Across the countries studied, the percentage of home deaths rose from 30.1 % in 2012-2013 to 30.9 % in 2018-2019, and even more to 32.2 % during the pandemic (2020-2021). Of the deaths analysed, an estimated 20.4 % died from cancer and 5.8 % from dementia. Overall, 30.8 % of deaths occurred at home. An increase in home deaths during the pandemic was noted in 23 of the 32 countries studied, with the highest in Northern Ireland (27.5 % in 2018-2019 and 33.1 % in 2020-2021). Of the six countries with decreases in home deaths, the greatest difference was observed in Uganda (76.6 % to 47.8 %). “The increase in home deaths was higher for women and cancer patients in most countries”, study co-authors Drs Barbara Gomes and Sílvia Lopes of EOLinPLACE project coordinator University of Coimbra, Portugal, explain in an article posted on the university’s website. “There are several possible explanations for the observed sex difference, including women’s greater involvement in discussions about end-of-life care planning and resistance to hospital admission.” The reason cited for the rise in home deaths among people with cancer was “the more predictable course of the disease compared with non-malignant conditions, as well as earlier and better integrated palliative care.”
What this means to the world
The researchers explain the study’s relevance: “If the shift we found towards dying at home is adequately supported, aligned with preferences and associated with good outcomes, such as improved symptom control and quality of life for both the patient and their family, we are in [sic] the right track facing a complex health transition. If, on the other hand, deficits in end of life care are found, with the risk of failing patients and families, we must rethink and improve home support, considering reallocation of resources from other places.” The study highlights the importance of future national and international health policies taking heed of this shift towards dying at home so as to ensure that palliative and end-of-life care resources are appropriately allocated. The EOLinPLACE (Choice of where we die: a classification reform to discern diversity in individual end of life pathways) project ends in 2026. For more information, please see: EOLinPLACE project website
Keywords
EOLinPLACE, death, home death, COVID-19, pandemic, end-of-life
