The study, Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world, published in the journal, Palliative Medicine, analysed vital statistics to reveal that the proportion of people dying in hospitals in Portugal has risen from less than half to almost two thirds since 1988. The study authors also found a dramatic rise for those aged 85 years and older (28% in 1988 to 54% in 2010).
Portugal is one of 39% of countries worldwide without integrated palliative care. By 2050 it will be the second most ageing population in the world (after Japan). There is only one palliative care service per 170,000 residents in the country, with some services providing support both in hospital and in the community.
According to the national directory of services of the Portuguese Association for Palliative Care, 20 out of 61 services provide home care.
Following world trends, the annual number of deaths in Portugal is predicted to rise; in this context, if nothing is done, and trends continue, three out of four people will die in hospital by 2030. The number of hospital deaths of people aged 85+ would double. This is neither sustainable nor desired by the population.
Previous research published in Palliative Medicine suggests that with targeted national strategies focused on developing palliative care support in the community it is possible to influence hospitalised dying trends and enable more people to die at home. This aligns with the recent WHO resolution that urges countries to develop integrated models of palliative care, mainly focused on primary care, community and home care services.
Dr Vera Sarmento, first author of the study, said: “Portugal is one of the most ageing countries in the world and it has one of the fastest hospitalised dying trends. This is worrying, especially if we take into account that a preference for dying at home is more common in the older age groups. Yet older people (aged 85 years or over) are more likely to die in hospital than their younger counterparts, as we show in the study. We therefore need a national strategy focused on the development of home palliative care, ensuring also the availability of other forms of community support so that more Portuguese are able to be cared for and die at home, according to their individual preferences.”
“We are facing a serious public health problem that can no longer be ignored. The trend we observed in Portugal is neither sustainable nor desired by the population,” said Dr Barbara Gomes, senior lead of the research team who conducted the study. “We know, based on data from other countries, that it is possible to invert hospitalised dying trends with national strategies focused on home palliative care.
“Portugal needs a new national palliative care programme (the last one was written in 2010) to ensure that in a year’s time there are home palliative care teams, with appropriate skills and resources, in all regions of the country. We must plan now so that, in the future and irrespective of where people live, they are able to spend their last months, weeks and days of life where they wish to be, with the best quality of life possible and well supported.”
Access the study online via the Palliative Medicine website.
This research was funded by the Calouste Gulbenkian Foundation.