Search

Table of contents

The level of need in the population

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

Mortality

From 2003 to 2010, sudden deaths accounted for about 22% of deaths in Medway during this period. Table 1 shows that in 2010, there were over 2,000 deaths in Medway, implying that 1,699 people in Medway who died that year may have benefited from an end of life care.

  Sudden death Not sudden death Total number of deaths % sudden death
2003 560 1,723 2,283 24.5
2004 557 1,588 2,145 26.0
2005 504 1,673 2,177 23.2
2006 482 1,739 2,221 21.7
2007 453 1,601 2,054 22.1
2008 495 1,616 2,111 23.4
2009 397 1,614 2,011 19.7
2010 391 1,699 2,090 18.7
Table 1: Total number of deaths and proportion of sudden deaths in Medway 2003–2010

Figure 1 shows that the majority of these deaths occurred following a period of chronic illness, where deaths could have been anticipated and care properly planned.

Figure 1: Number of deaths registered in 2010 in Medway by underlying cause of death
Figure 1: Number of deaths registered in 2010 in Medway by underlying cause of death

The three main diseases which contributed to 75% of all deaths were: cancers (neoplasms) -679 deaths (32.5%); circulatory diseases- 557 deaths (26.7%); respiratory diseases -333 deaths (15.9%).

Death rates increase steeply with age, with 79.4% (1,659) of deaths occurring in people aged over 65 years and 62.4% (1,305) in people over 75.

Figure 2: Number of deaths registered in 2010 in Medway by age
Figure 2: Number of deaths registered in 2010 in Medway by age

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.

In 2010/11, over half (52%) of the 2,090 deaths in Medway occurred in hospital as shown in Figure 3 below.

Figure 3: Proportion of deaths by place of death in Medway (2010/11)
Figure 3: Proportion of deaths by place of death in Medway (2010/11)
Figure 4: Trends in place of death in Medway
Figure 4: Trends in place of death in Medway

Figure 5 shows that from 75 onwards the proportion of people dying in hospital increases exponentially.

Figure 5: Number of deaths registered between January 2008 and December 2010 in Medway by age band and place of death
Figure 5: Number of deaths registered between January 2008 and December 2010 in Medway by age band and place of death

In Medway, the proportion of deaths in hospital has fallen from 58% in 2002 to 38% in 2011. In the same period, the proportion of deaths occurring at people's homes increased from 18% in 2002 to 34% in 2011. Figure 4 suggests a significant improvement with more deaths within Medway occurring at home. However, further work is still needed to ensure equality in access to services for all relevant conditions.

It is worth noting that, more deaths, especially due to respiratory conditions tend to occur during the winter months, between December and March each year.

Inequalities

The evidence suggests that there is inequality in end of life outcomes amongst the UK population. The groups experiencing less favourable outcomes include: older people, those with dementia and learning disabilities, those with non-cancer diagnosis and black and minority ethnic (BME) groups.[1]

In Medway, 72.9% of deaths occur in people over the age of 65 and 62.4% in those over 85, suggesting poor access to end of life services for older people. This group have complex needs due to their frailty, co morbidities and increased reliance on support from older carers.

Figure 1 shows the number of deaths from cancer (679), circulatory disease (557) and respiratory disease (333). A proportion of these groups will also have had dementia. It is estimated that for those over 85, the prevalence of dementia is 21%.[2] This represents a significant group with unmet needs, people whose preferences for end of life care may not have been identified earlier and then provided appropriate support.

In 2010, 32.5% of deaths were attributed to cancers in Medway, suggesting a large proportion of patients with non cancer diagnosis. The majority of these patients are older and frailer than those with cancer and thus requiring more support for longer periods.[3]

Deprivation is a known risk factor for health inequalities and has been identified as a risk indicator for poor end of life care outcomes.[4] Social factors such as deprivation (lower income) increased age, and coming from a minority ethnic descent were associated with fewer home deaths. This may be explained by the lower income and resources available to afford adequate care at home.[5]

Palliative care register

The number of deaths due to long term conditions (2,090) when compared with the number of patients registered on the Quality of Outcomes Framework (QOF) palliative care register (421) indicates that patients are not being identified in their last year of life.


References

[1]   National Institute for Health and Clinical Excellence. Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer: The Manual 2004; National Institute for Health and Clinical Excellence. www.nice.org.uk/nicemedia/pdf/csgspmanual.pdf .
[2]   Hofman A, Rocca W, Brayne C, et al. The Prevalence of Dementia in Europe: A Collaborative Study of 1980--1990 Findings International Journal of Epidemiology 1991; 20: 736-748.
[3]   Murray S, Sheikh A. Palliative Care Beyond Cancer British Medical Journal 2008; 336: 958-959.
[4]   Gomes I. Factors influencing death at home in terminally ill patients with cancer: systematic review British Medical Journal 2006; 332 (7540): 515-521.
[5]   Higginson I, Jarman B, Astin P, et al. Do social factors affect where patients die: an analysis of 10 years of cancer deaths in England Journal of Public Health Medicine 1999; 21(1): 22-28.