Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world

Background: Monitoring where people die is key to ensure that palliative care is provided in a responsive and integrated way. Aim: To examine trends of place of death and project hospital deaths until 2030 in an ageing country without integrated palliative care. Design: Population-based observational study of mortality with past trends analysis of place of death by gender, age and cause of death. Hospital deaths were projected until 2030, applying three scenarios modelled on 5-year trends (2006-2010). Setting/participants: All adult deaths (>= 18 years old) that occurred in Portuguese territory from 1988 to 2010. Results: There were 2,364,932 deceased adults in Portugal from 1988 to 2010. Annual numbers of deaths increased 11.1%, from 95,154 in 1988 to 105,691, mainly due to more than doubling deaths from people aged 85+ years. Hospital deaths increased by a mean of 0.8% per year, from 44.7% (n = 42,571) in 1988 to 61.7% (n = 65,221) in 2010. This rise was largest for those aged 85+ years (27.8% to 54.0%). Regardless of the scenario considered, and if current trends continue, hospital deaths will increase by more than a quarter until 2030 (minimum 27.7%, maximum 52.1% rise) to at least 83,293 annual hospital deaths, mainly due to the increase in hospital deaths in those aged 85+ years. Conclusion: In one of the most ageing countries in the world, there is a long standing trend towards hospitalised dying, more pronounced among the oldest old. To meet people's preferences for dying at home, the development of integrated specialist home palliative care teams is needed.