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 long-term 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 deaths, while focusing specialized end-of-life care services on married people or those aged 65 to 79 might be crucial for achieving home death. However, proper end-of-life care needs to be ensured in hospitals, should this be the most appropriate end-of-life care setting.

Aging Research Center Karolinska Institutet and Stockholm University Stockholm Sweden; French National Observatory on End of Life Care Paris France

Brown University School of Public Health Providence RI

Center for Palliative Care Prague Czech Republic

Department of Family Medicine and Chronic Care End of Life Care Research Group Vrije Universiteit Brussel and Ghent University Brussels Belgium

Department of Family Medicine and Chronic Care End of Life Care Research Group Vrije Universiteit Brussel and Ghent University Brussels Belgium; Department of Medical Oncology Ghent University Hospital Ghent Belgium

Department of Health Sciences Dongduk Women's University Seoul South Korea

Department of Information and Evaluation Regional Ministry of Equality Health and Social Policies in Andalusia Seville Spain

Department of Public and Occupational Health EMGO Institute for Health and Care Research and Expertise Center for Palliative Care VU University Medical Center Amsterdam The Netherlands

Faculty of Health Sciences University of Southampton Southampton Hampshire UK

Faculty of Nursing University of Alberta Edmonton Alberta Canada

Hospice Waikato Hillcrest Hamilton New Zealand

MD Anderson Cancer Center Department of Leukemia University of Texas Houston TX

National Institute of Statistics Rome Italy

University of Pécs Medical School Pécs Hungary

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