Place of death and end-of-life transitions experienced by very old people with differing cognitive status: Retrospective analysis of a prospective population-based cohort aged 85 and over

Anouk J. Perrels, Jane Fleming, Jun Zhao, Stephen Barclay, Morag Farquhar, Hilde M. Buiting, Carol Brayne, The Cambridge City over-75s Cohort (CC75C) study collaboration

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Background: Despite fast-growing ‘older old’ populations, ‘place of care’ trajectories for very old people approaching death with or without dementia are poorly described and understood. Aim: To explore end-of-life transitions of ‘older old’ people across the cognitive spectrum. Design: Population-based prospective cohort (United Kingdom) followed to death. Setting/participants: Mortality records linked to 283 Cambridge City over-75s Cohort participants’ cognitive assessments <1 year before dying aged ≥85 years. Results: Overall, 69% were community dwelling in the year before death; of those with severe cognitive impairment 39% were community dwelling. Only 6% subsequently changed their usual address. However, for 55% their usual address on death registration was not their place of death. Dying away from the ‘usual address’ was associated with cognition, overall fewer moving with increasing cognitive impairment – cognition intact 66%, mildly/moderately impaired 55% and severely impaired 42%, trend p = 0.003. This finding reflects transitions being far more common from the community than from institutions: 73% from the community and 28% from institutions did not die where last interviewed (p < 0.001). However, severely cognitively impaired people living in the community were the most likely group of all to move: 80% (68%−93%). Hospitals were the most common place of death except for the most cognitively impaired, who mostly died in care homes. Conclusion: Most very old community-dwelling individuals, especially the severely cognitively impaired, died away from home. Findings also suggest that long-term care may play a role in avoidance of end-of-life hospital admissions. These results provide important information for planning end-of-life services for older people across the cognitive spectrum, with implications for policies aimed at supporting home deaths.
Original languageEnglish
Pages (from-to)220-233
Number of pages14
JournalPalliative Medicine
Issue number3
Early online date6 Dec 2013
Publication statusPublished - 1 Mar 2014


  • Cognitive impairment
  • dementia
  • aged
  • 80 and over
  • frail elderly
  • patient transfer
  • residential characteristics
  • homes for the aged
  • nursing homes
  • delivery of health care
  • terminal care

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