• Vol. 38 No. 8, 676–683
  • 15 August 2009

Where the Elderly Die: The Influence of Socio-Demographic Factors and Cause of Death on People Dying at Home

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ABSTRACT

Introduction: The place of death of the elderly has implications on the overall healthcare delivery system. The aim of this study is to describe where deaths of elderly occur in Singapore and to determine the association of socio-demographic characteristics and the causes of death on dying at home. Materials and Methods: Data of 10,399 Singapore resident decedents aged 65 years and above in 2006 were obtained from the national Registry of Births and Deaths. Distributions of socio-demographic characteristics and causes of death by place of death were analysed, and associations between socio-demographic characteristics and home death for major causes of death were assessed by logistic regression models controlling for age, gender and ethnic group. Results: Most elderly deaths occurred in hospitals (57%), followed by deaths at home (31%). The proportion of deaths at home increased with age while deaths in hospital declined with age. Significantly more elderly women died at home compared to men. Malay elderly had the highest proportion of home deaths (49%), and the lowest proportion of hospital deaths (47%). Elderly persons who died from stroke were most likely to die at home [odds ratio (OR) 2.8, 95% confidence interval (CI), 2.3-3.3] while those who died from lung and respiratory system diseases were less likely to die at home (OR, 0.7; 95% CI, 0.6-0.8). Conclusion: Elderly people in Singapore die mainly in hospitals. About a third of them die at home. The proportion of decedents dying at home increased with age. Home deaths among the elderly are most likely in those aged 85 years and above, females, Malays, and those who die of stroke.


The subject of place of death was brought to the forefront of the medical community in July 2004 when 2 important publications were released; one by the World Health Organization1 and another from the House of Commons Select Committee on Health.2 Both reports highlighted that the proportion of deaths at home has been decreasing while that of hospital deaths has been increasing. The reports also pointed out a lack of congruence in that many patients died in hospitals, even though their expressed wishes were to spend their final days at home.1,2 The reports also discussed the wider implications on healthcare services, and the urgency to tackle the issues, as the place of death is where the patient will receive the care in his final illness. A study in the UK projected that deaths at home was likely to reduce by 24%, with fewer than 1 in 10 dying at home by 2030.3 In the USA, place of death was brought to public attention by the SUPPORT STUDY (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment published in 19954 and the Institute of Medicine report “Approaching death: Improving care at the end of life” in 1997.5

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