Home Medizin Studie zeigt einen Anstieg der Todesfälle zu Hause in 32 Ländern

Studie zeigt einen Anstieg der Todesfälle zu Hause in 32 Ländern

von NFI Redaktion

In a recent study published in The Lancet’s EClinicalMedicine, researchers examined changing trends in places of death in 32 countries during and before the 2019 coronavirus pandemic (COVID-19) to better understand the pandemic’s broader impacts on global mortality patterns and health. Study: The rise in home deaths during the COVID-19 pandemic: a population-based study using adult death certificate data from 32 countries, 2012–2021. Image Source: Andrii Vodolazhskyi/Shutterstock.com Background The severity of the initial acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the absence of existing immunity or vaccines against the virus led to the COVID-19 pandemic posing an unexpected burden on health systems worldwide. Hospitals had to not only accommodate severe COVID-19 cases but also find ways to continue providing care to critically ill patients, who also faced an increased risk of SARS-CoV-2 infections. The high mortality rates associated with COVID-19 also increased the burden on hospitals as they were forced to admit more patients with severe SARS-CoV-2 infections. On the other hand, families of critically ill patients had to grapple with the question of whether patients should be admitted to hospitals, given the high likelihood of COVID-19 transmission in the hospital and pandemic-related visitation restrictions. There were many reports of patients dying in hospitals without their families present. These pandemic-induced changes also impacted the development of places of death. About the Study In the present study, researchers used data from health authorities and national statistical offices from 32 countries on essential registration information such as death certificates to examine the trends in adult mortality in relation to place of death in the first years of the COVID-19 pandemic, 2020 and 2021. This was compared with trends observed in the eight years prior to the pandemic, from 2012 to 2019. Research has indicated that home is one of the most preferred places of death for patients with life-threatening illnesses and their families, with palliative care facilities and hospices being the next preferred options. For many patients and their families, the autonomy, dignity, presence of loved ones, comfort, and familiarity associated with home make it a preferred place for spending their final days. However, the deteriorating clinical condition and the burden on caregivers also contribute to the fact that many patients do not prefer to die at home. Nevertheless, the personal preferences of patients and their families do not always align with reality, and the place of death often depends on socio-economic factors as well.Based on the available data, the places of death were categorized into home, inpatient, non-inpatient, and various other categories, as the data varied significantly from country to country. The data were aggregated by age group, gender, and cause of death, including cancer, dementia, and COVID-19. The percentages and numbers of deaths were calculated by place of death, gender, country, cause of death, and age groups. The percentage of home deaths was plotted against the time trends for the two years of the COVID-19 pandemic and the preceding eight years. The place-of-death trends were also recorded for each country individually and based on the United Nations regions. The percentage of home deaths was also age standardized to assess age distribution differences in home deaths. Results The results indicated an increase in the number of home deaths during the COVID-19 pandemic, although the percentage of home deaths varied considerably with regard to numerous parameters, including age, country, cause of death, and gender. The increase in the number of home deaths was higher for females than for males, which the researchers attribute to a greater female involvement in end-of-life care planning and avoidance of hospital admissions. While the differences in the percentages of home deaths in different age groups were not consistent across individual countries, there was an increase in the number of home deaths due to cancer. The researchers suggest that, unlike non-malignant conditions, cancer has a more predictable disease trajectory, and the increase in home deaths related to cancer could be attributed to earlier and improved palliative care. Only 8.3% of all deaths were attributed to COVID-19, indicating that a significant portion of home deaths was due to other critical illnesses for which palliative care was an option. The study also discussed the role of rapidly growing telemedicine in providing support and information to caregivers, enabling them to care for patients at home, which may have contributed to the increase in home deaths. Conclusions Overall, the results suggest that the COVID-19 pandemic led to a significant increase in the number of home deaths, but the trends varied by country and age group. Additionally, the increase in home deaths was higher for women and cancer patients. The researchers believe that the rapid expansion of telemedicine during the pandemic may have played a role in the increased number of home deaths.Journal Reference: Lopes, S., Bruno, Delalibera, M., Namukwaya, E., Cohen, J. & Gomes, B. (n.d.). The rise in home deaths during the COVID-19 pandemic: a population-based study using adult death certificate data from 32 countries, 2012–2021. EClinicalMedicine. doi:https://doi.org/10.1016/j.eclinm.2023.102399. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00576-X/fulltext

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