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Boost needed in healthcare for centenarians

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Centenarians are more likely to have causes of death certified as pneumonia and frailty

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People aged 100 years or over are a rapidly growing demographic group worldwide in 2011, there were 317,000 centenarians worldwide. It is estimated that this number will increase to 3,224,000 by 2050, reaching 17,795,000 at the end of the century. In the United Kingdom, the number of centenarians has steadily increased since 1956 with numbers roughly doubling every 10 years and estimated to reach over half a million by 2066.

Studies are limited when it comes considering the explicit health and social care needs of centenarians compared to younger cohorts of older people or the implications of extreme longevity for policy and service delivery.

In this population-based observational study, researchers from King's College London had examined trends in place of death and associations for centenarians in England over 10 years to consider policy implications of extreme longevity.

The team examined the cause and place of death 35,867 people with a median age at death of 101 years (range: 100–115 years), in England between 2001 and 2010 and compared with those dying at ages 80 to 99. The study also looked at factors such as the effect of socioeconomic deprivation on place of death.

The results showed the number of centenarian deaths per year in England increased by 56% in 10 years from 2,823 in 2001 to 4,393 in 2010. This ten year study consisted of 35,867 people with a median age of 101 years (range: 100–115 years) at time of death who were mainly women (86.7%) and widowed (85.0%). Areas of highest deprivation in the UK had the lowest proportion of centenarian deaths, with most centenarians having died in in a residential care home (34.5%) or nursing home (26.7%) with few centenarians dying at home (9.6% or in a hospice (0.2%) and over one quarter (27.2%) died in a hospital. The North East of England had the lowest overall proportion of centenarian deaths (4%).

The most common cause of certifying death was old age at 28% followed by pneumonia at 17.7%and other respiratory diseases 6.0%. Cerebrovascular 10.0%, ischemic heart diseases 8.6% and other circulatory diseases 9.8%, dementia and Alzheimer disease 5.7%, cancer 4.4% and senility “old age” 28.1%. Old age formed the largest category. However, trends in certifying death as “old age” showed a decreasing trend over 10 years, notably in hospital −0.87% annually with increasing use of dementia 0.34% annually.

In their conclusion the researchers write “Centenarians are more likely to have causes of death certified as pneumonia and frailty and less likely to have causes of death of cancer or ischemic heart disease, compared with younger elderly patients. To reduce reliance on hospital care at the end of life requires recognition of centenarians’ increased likelihood to “acute” decline, notably from pneumonia, and wider provision of anticipatory care to enable people to remain in their usual residence, and increasing care home bed capacity.”

Dr. Catherine Evans, PhD, MSc, BSc, RN, NIHR, Clinical Lecturer in Palliative Care/CNS at the Cicely Saunders Institute, King's College London commented "Centenarians have outlived death from chronic illness, but they are a group living with increasing frailty and vulnerability to pneumonia and other poor health outcomes. We need to plan for health care services that meet the 'hidden needs' of this group, who may decline rapidly if they succumb to an infection or pneumonia. We need to boost high quality care home capacity and responsive primary and community health services to enable people to remain in a comfortable, familiar environment in their last months of life.”

"Compared to other European countries the proportion of people aged 90 years and over dying in hospital in England is high, and the number dying in care homes is low. For example, in the Netherlands and Finland more than three-quarters of people aged over 90 die in a long-term care setting such as a nursing home; far fewer die in hospital.”

"Hospital admission in the last weeks of life accounts for a third of the total cost of end-of-life care per patient. Increasing the number of care home beds could reduce the reliance on hospital care, but we need to ensure caliber services are provided by GPs, community nurses and other healthcare working with social care providers to enable people to remain in their usual residence at the end of life if they choose."

This study was funded by the National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme.

This study has been published in the journal PLOS Medicine

Citation

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