Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Background: Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. Aim: To examine the place of residence or care of ≥85 year-olds less than a year before death, and their place of death, and to map individual changes between the two. Design of study: Population-based cohort study. Setting Cambridge City over-75s Cohort (CC75C) study, UK. Method: Retrospective analysis of prospective data from males and females aged ≥85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. Results: Only 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. Conclusion: More than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old.