Where do older people die? A nationwide study in France (1990-2010)

Objectives. - We aimed to measure the variation in the place of death of older people in France between 1990 and 2010. Methods. - Retrospective, population-based study of death-certificate data. All decedents aged 75 or older who died in 1990, 2000 and 2010 were included (n = 1,001,848). Projections from 2010 to 2050 were developed using previous estimates reported by France's national institute for statistics and economic studies (Insee). Results. - Between 1990 and 2010, the proportion of home deaths decreased from 28.5 to 24.5%, while the proportion of deaths occurring in nursing home facilities increased (13.2 to 15.8%). In-hospital death rates remained stable over the study period (55.5 to 55.9%). After adjusting for individual-level variables, older people who died in 2010 had a reduced likelihood of dying at home (Odds Ratio [OR] = 0.81; 95% CI = 0.80-0.82) and increased odds of dying in hospitals (OR = 1.05; 95% CI = 1.04-1.06) or in nursing homes (OR = 1.15; 95% CI = 1.13-1.17), compared with 1990 decedents. If these trends continue, the number of deaths occurring in nursing home facilities is projected to be multiplied by 3.7 in 2050. Conclusions. - Our study demonstrates that the likelihood of dying at home decreased over the last 20 years, while the proportion of older people dying in nursing homes and in hospitals significantly increased. Beyond the ethical and social concerns that these changes might raise, from a demographic and macroeconomic perspective, this process of medicalization and institutionalization of death seems unsustainable for the healthcare system. (C) 2015 Elsevier Masson SAS. All rights reserved.