Western Canadians' end-of-life wishes not fulfilled: study

Despite their wishes to die at home when the time comes, more than half of western Canadians die in ahospital, according to an end-of-life study published Thursday by the Canadian Institute for Health Information.

The study, which involved 37,000people, found that 58 per cent of westerners who died in 2003 and 2004 passed away in a hospital. In Manitoba, that number was 68 per cent, while in Alberta the number was 65 per cent. BritishColumbia stood at 52 per cent and Saskatchewan at 50 per cent.

Yet, when asked, most people have indicated in previous studies that they would prefer to die on their own terms, CIHI said.

"We're seeing that over half of people die in hospital even though most people express an interest at some point to die at home," Bernie Paille, special projects lead at CIHI in Victoria,told CBC News on Thursday.

"There's a disconnect there and it's important to understand what issues lead to that."

He said many people die in hospital while they're receiving care for acute medical conditions or while receiving palliative care.

For the purpose of the study, those people who died were classified into four categories based on causes of death: terminal illness, organ failure, frailty and sudden death. Organ failure accounted for 33.8 per cent of adult deaths, followed by terminal illness at 29.3 per cent and frailty at 28.4 per cent.

Sudden death accounted for 5.6 per cent of all deaths.

Terminal illness patients, including those with cancer, were the most likely to have died in a hospital (68 per cent), compared to organ failure (62 per cent), frailty (50 per cent) or sudden death (29 per cent) patients.

Health authorities planning for boomers

End-of-life care has recently been focused on as health authorities attempt to alter their practices in anticipation of the massive increase in the number of Canadian seniors in the next decade.

Because of the aging of the baby-boom cohort, the number of annual deaths in Canada could increase by as much as 65 per cent by the year 2036, CIHI said.

"This generation of baby boomers is a big chunk of the population and they have needs that need to be addressed," said Paille. "I think there's enough here for the health authorities to say: 'Well, there's enough information here for us to be able to learn from this region or that region.' "

"Knowing where people die and the extent to which hospital care and pharmaceuticals are used can assist in these planning efforts," said the report.

Health authorities are concerned aboutthe steep medical costs generated by older patients, which are driving up prescription drug bills and hospital costs. As the length of life and the time spent living with chronic conditions have increased, so, too, have associated medical expenditures.

The study found a sharp increase in health spending by age, with more than 40 per cent of total health-care spending accounted for by those 65 and older, although they account for less than 20 per cent of the total Canadian population.

"On a per capita basis, seniors account for the lion's share of provincial health-care spending in western Canada," reads the report.

"I think the delivery of health services in local areas is certainly something that each health authority will take a look at and better understand the nature of the care they're providing now and to plan for the future," said Paille.