Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home

<p><b>INTRODUCTION</b>The place of death of the elderly has implications on the overall healthcare delivery system. The aim of this study is to describe where deaths of elderly occur in Singapore and to determine the association of socio-demographic characteristics and the causes of death on dying at home.</p><p><b>MATERIALS AND METHODS</b>Data of 10,399 Singapore resident decedents aged 65 years and above in 2006 were obtained from the national Registry of Births and Deaths. Distributions of socio-demographic characteristics and causes of death by place of death were analysed, and associations between socio-demographic characteristics and home death for major causes of death were assessed by logistic regression models controlling for age, gender and ethnic group.</p><p><b>RESULTS</b>Most elderly deaths occurred in hospitals (57%), followed by deaths at home (31%). The proportion of deaths at home increased with age while deaths in hospital declined with age. Significantly more elderly women died at home compared to men. Malay elderly had the highest proportion of home deaths (49%), and the lowest proportion of hospital deaths (47%). Elderly persons who died from stroke were most likely to die at home [odds ratio (OR) 2.8, 95% confidence interval (CI), 2.3-3.3] while those who died from lung and respiratory system diseases were less likely to die at home (OR, 0.7; 95% CI, 0.6-0.8).</p><p><b>CONCLUSION</b>Elderly people in Singapore die mainly in hospitals. About a third of them die at home. The proportion of decedents dying at home increased with age. Home deaths among the elderly are most likely in those aged 85 years and above, females, Malays, and those who die of stroke.</p>

Amendment of the Human Organ Transplant Act

On 6 January 2004, the Human Organ Transplant Act (HOTA) was amended to allow more Singaporeans to benefit from organ donation. The main amendments to HOTA were (a) to extend HOTA beyond kidneys to include livers, hearts and corneas; (b) to extend HOTA beyond deaths due to accidents to include all causes of deaths; and (c) to extend HOTA beyond cadaveric organ donation to also regulate living donor organ transplants. In this article, we review the amendments to HOTA and the Interpretation (Determination and Certification of Death) Regulations and examine the impact of HOTA on organ procurement and transplantation in Singapore.