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The level of need in the population

Adults :: End of life :: The level of need in the population

The majority of deaths (n = 1778) in 2016, were predictable (i.e. non-sudden (see definition below), occurring following a period of chronic illness), where deaths could have been anticipated and care properly planned.

Definition of sudden deaths: Sudden deaths are defined as those occurring due to the following causes: acute myocardial infarction; pulmonary embolism; aneurysm of pulmonary artery; sudden cardiac death; cerebrovascular diseases; aortic aneurysm and dissection; influenza and pneumonia; other acute lower respiratory infections; suppurative and necrotic conditions of lower respiratory tract; other diseases of the pleura; post-procedural respiratory disorders; respiratory failure; injury, poisoning and certain other consequences of external causes; external causes of morbidity and mortality.

Table 1 shows that the proportion of non-sudden deaths has increased over the last 10 years, implying that the number of people in Medway who could benefit from end-of-life care is increasing.

  Sudden death Non-sudden death Total number of deaths % non-sudden death
2007 414 1,455 1,869 77.8
2008 495 1,615 2,110 76.5
2009 396 1,613 2,009 80.3
2010 391 1,698 2,089 81.3
2011 404 1,607 2,011 79.9
2012 400 1,730 2,130 81.2
2013 378 1,693 2,071 81.7
2014 421 1,806 2,227 81.1
2015 421 1,892 2,313 81.8
2016 364 1,778 2,142 83.0
Table 1. Total number of deaths and proportion of non-sudden deaths in Medway 2007-2016 [1]

In 2016, the four main underlying causes of non-sudden death in Medway were: cancers (neoplasms) - 687 deaths (38.6%); circulatory diseases - 292 deaths (16.4%); mental and behavioural - 231 deaths (13.0%); respiratory diseases - 207 deaths (11.6%). With active case finding and good disease management the majority of these deaths could be anticipated and the end-of-life adequately planned for.

Place of death

Most people die in hospital, although their preferred place of death would be at home, as long as high quality care is received with minimal burden to their families and carers.[2] Figure 1 shows the place of death recorded for Medway residents in 2016 for non-sudden deaths (hospital includes deaths in an acute or community hospital, not psychiatric).[1]

Figure 1: Place of death (non-sudden)
Figure 1: Place of death (non-sudden) [1]

Figure 2 shows that in Medway, the proportion of deaths in hospital has risen from 44.7% in 2011/12 to 47.0% in 2015/16 (hospital deaths include deaths occurring in a community hospital) while in England during the same period, the proportion of deaths in hospital has fallen from 50.4% to 48.2%. The proportion of deaths occurring at people's homes in this time frame has stayed approximately the same at around 25% for Medway, however the proportion of deaths occurring in a hospice or care home has decreased. This suggests further work is still needed to ensure equality in access to services for all relevant conditions.

Figure 2: Trends in place of death in Medway
Figure 2: Trends in place of death in Medway [2]


[1]   Medway Public Health Intelligence Team. Primary Care Mortality Database Analysis
[2]   National End of Life Care Intelligence Network. Place of death