1. South West Public Health Observatory New insights into place of death for people with Alzheimer’s disease, dementia and senility Dr Julia Verne

2. South West Public Health Observatory AUTHORS: Adebowale Osinowo Stuart Harris Davidson Ho Julia Verne

3. South West Public Health Observatory Deaths in Older Adults in England report showed: 66.8% of alldeaths in people >75 1 in 6 >90 Dementia and/or senility is top causes of death >80 Number of people aged >75 projected to increase from 4.0 million to 7.2 million by 2033 Number of people aged >90 projected to increase from 0.4 million to 1.2 million by 2033

4. South West Public Health Observatory Dementia UK estimates a prevalence of people living with dementia of > 600,000 i.e. 1.2% of the population By 2030 it is estimated that there will be over 1,000,000 people living with dementia People living with and dying with dementia are often physically also very frail. But Important issues related to the individuals ability to express their autonomy re end of life decisions

5. South West Public Health Observatory METHODS  Mortality data was extracted from ONS annual mortality extract for years 2007-09  Deaths Registered in England by  Cause of death <  Age categories definitions

6. South West Public Health Observatory Cause of deathICD 10 codes Dementia (includes vascular and unspecified dementia) F01, F03 (any 4th digit) Alzheimer’s diseaseG30 (any 4th digit) Senility (without mention of psychosis)R54 (any 4th digit) ICD Classification

7. South West Public Health Observatory DEFINITIONS Underlying cause of death, defined as: i)the disease or injury that initiated the train of events directly linked to death; or ii)the circumstances of the accident or violence that produced the fatal injury. Contributory cause of death, defined as: part of the causal sequence of events leading to death, or contributing to the death but not part of the causal sequence. Mention, defined as: a death which has a condition listed as either the underlying cause of death or as a contributory cause of death.

8. South West Public Health Observatory Underlying and contributory cause of death coding combinations, England, 2001 to 2009 Cause of death Underlying coding Contributory coding Dementia Alzheimer’s disease SenilityTotal Dementia117,582x8835,30235,390 Alzheimer’s disease 43,9401,914x8,92610,840 Senility86,04730x3 All other4,091,673165,73523,248218,740407,723 Total4,339,242167,65223,336262,968453,956

9. South West Public Health Observatory Trends in Alzheimer’s disease, dementia and senility as underlying causes of death, England, 2001 to 2009 Source: Office for National Statistics, annual mortality extracts

10. South West Public Health Observatory Trends in Alzheimer’s disease, dementia and senility as contributory causes of death, England, 2001 to 2009 Source: Office for National Statistics, annual mortality extracts

11. South West Public Health Observatory Trends in mentions of deaths for Alzheimer’s disease, dementia and senility, England, 2001 to 2009 Source: Office for National Statistics, annual mortality extracts

12. South West Public Health Observatory Age and sex distribution of people who died with dementia recorded as either the underlying or contributory cause, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

13. South West Public Health Observatory Age and sex distribution of people who died with Alzheimer’s disease recorded as either the underlying or contributory cause, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

14. South West Public Health Observatory Age and sex distribution of people who died with senility recorded as either the underlying or contributory cause, England, 2007 or 2009 Source: Office for National Statistics, annual mortality extracts

15. South West Public Health Observatory Alzheimer’s disease, dementia and senility as underlying causes of death, by place of death, England, 2007 to 2009 Hospital Old people’s home Nursing home Own residence HospiceElsewhereTotal n%n%n%n%n%n%n% Dementia17,6803911,3362513,623301,993452<1194 <144,878100 Alzheimer's disease 5,734344,650275,357311,192741<178 <117,052100 Senility4,061168,798357,781314,14017 <1289 125,086100 Total27,4753224,7842826,761317,3258110<1561 187,016100 Source: Office for National Statistics, annual mortality extracts

16. South West Public Health Observatory Alzheimer’s disease, dementia or senility as contributory causes of death, by place of death, England, 2007 to 2009 Hospital Old people’s home Nursing home Own residence HospiceElsewhereTotal n%n%n%n%n%n%n% Dementia36,4505312,6331816,229233,3565294<1276<169,238100 Alzheimer's disease 4,584521,604181,8242166689815018,826100 Senility32,2933424,6772625,7512711,58512175<1777195,258100 Total73,3274238,9142243,8042515,6079567<11,1031173,322100 Source: Office for National Statistics, annual mortality extracts

17. South West Public Health Observatory Place of death distribution for females aged 65+ with underlying cause of death of Alzheimer’s disease, dementia or senility, England, 2007 to 2009 Place of death distribution for females aged 65+ with contributory cause coding of Alzheimer’s disease, dementia or senility, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

18. South West Public Health Observatory Age and sex distribution of people who died with circulatory disease as the underlying cause of death, with and without Alzheimer’s disease, dementia and senility contributory cause codings, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

19. South West Public Health Observatory Place of death distribution for males and females aged 65+ with circulatory diseases as the underlying cause of death, with and without contributory cause codings for Alzheimer’s disease, dementia or senility, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

20. South West Public Health Observatory Place of death distribution for males and females aged 65+ with malignant cancers as the underlying cause of death, with and without contributory cause codings for Alzheimer’s disease, dementia or senility, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

21. South West Public Health Observatory Place of death distribution for males and females aged 65+ with respiratory diseases as the underlying cause of death, with and without contributory cause codings for Alzheimer’s disease, dementia or senility, England, 2007 to 2009 Source: Office for National Statistics, annual mortality extracts

22. South West Public Health Observatory SUMMARY

23. South West Public Health Observatory www.endoflifecare-intelligence.o rg.uk