Health and care pathways in the last year of life from non-sudden causes between 2014 and 2023 in Wales: A population-scale retrospective cohort study

Background 

There will be an increased need for palliative care services across Wales as our ageing population increases and health and care services will need to manage this effectively.

The delivery of health and care services for patients nearing end-of-life can be complicated. This research aimed to measure the use of health and care services in the last year of life, before death from non-sudden (or ‘expected’) causes. The research will help to shape future planning for palliative and end-of-life care in Wales.

Aims

This study looked to discover differences in the uptake of health and care services in the last year of life for those known to the health service as needing end-of-life care (known as the “palliative care register”) and those not known, as well as understanding more about the different groups of people using the services.

Strategy 

Anonymised health and residential data from Welsh residents in their last year-of-life were collected. This information included patients who were at home, in a care home and in hospital.

Outcomes

This research found that most time at the end-of-life was spent at home with demand for urgent care increasing rapidly towards the end-of-life. 

The use of health and care services by patients living at home was higher in urban areas (cities and towns) compared to rural areas (countryside) and services were more likely to be used by patients who were known to the health service as needing end-of-life care compared to those who were not.

However, in contrast to this, the research found that for residents of care homes, those known to the health service as needing end-of-life care used health and care services in the last year-of-life less than those not known.

Some groups of people were under-represented on the palliative care register as potentially needing end-of-life care, including men, those in urban areas, people living in the most-deprived communities and those living alone. 

Targeted approaches for effectively identifying individuals needing end-of-life care at home, where appropriate, should be a priority in service provision. This will help to make the best use of health and care resources, and potentially improve outcomes for patients. 

Author | Mel McAulay, Public Member

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