Where people die (1974--2030): past trends, future projections and implications for care.

BACKGROUND Ageing nations have growing needs for end of life care, but these have never been projected in detail. We analysed past trends in place of death (1974-2003) and projected likely trends to 2030 in England and Wales and from these need for care. METHODS Mortality trends and forecasts were obtained from official statistics. Future scenarios were modelled using recent five-year trends in age and gender specific home death proportions to estimate numbers of deaths by place to 2030, accounting for future changes in the age and gender distribution of deaths. RESULTS Annual numbers of deaths fell by 8% from 1974 to 2003, but are expected to rise by 17% from 2012 to 2030. People will die increasingly at older ages, with the percentage of deaths among those aged 85 and expected to rise from 32% in 2003 to 44% in 2030. Home death proportions fell from 31% to 18% overall, and at an even higher rate for people aged 65 and over, women and noncancer deaths. If recent trends continue, numbers of home deaths could reduce by 42% and fewer than 1 in 10 will die at home in 2030. Annual numbers of institutional deaths (currently 440,936) will be 530,409 by 2030 (20% increase). CONCLUSIONS In England and Wales home deaths have been decreasing. The projections underline the urgent need for planning care to accommodate a large increase of ageing and deaths. Either inpatient facilities must increase substantially, or many more people will need community end of life care from 2012 onwards.