International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries

Objectives: The objective of this study was to examine variation in place of death of older people dying
from dementia in countries across 4 continents.
Design: Study of death certificate data.
Methods: We included deaths of older (65+ years) people whose underlying cause of death was a
dementia-related disease (ICD-10: F01, F02, F03, G30) in Belgium, the Netherlands, England, Wales,
France, Italy, Spain, Czech Republic, Hungary, New Zealand, United States, Canada, Mexico and South
Korea. We examined associations between place of death and sociodemographic factors, social support,
and residential and health care system factors.
Results: Overall, 4.8% of all deaths were from a dementia-related disease, ranging from 0.4% in Mexico to
6.9% in Canada. Of those deaths, the proportion occurring in hospital varied from 1.6% in the Netherlands
to 73.6% in South Korea. When controlling for potential confounders, hospital death was more likely for
men, those younger than 80, and those married or living in a region with a higher availability of longterm
care beds, although this could not be concluded for each country. Hospital death was least likely
in the Netherlands compared with other countries.
Conclusions: Place of death of older people who died from a dementia-related disease differs substantially
between countries, which might point to organizational differences in end-of-life care provision.
Increasing the availability of long-term care beds might be important to reduce the number of hospital