Unequal ends: A systematic review comparing place of death in rural, coastal and urban areas for older people with dementia to cancer.

Abstract

Despite the growing older population with increased chronic conditions in rural and coastal areas, it is currently unclear how location impacts where people die. To compare where people with dementia and people with cancer die across rural, coastal and urban areas, and examine associated factors. A systematic review reported in accordance with PRISMA guidelines. MEDLINE, PsycINFO, CINAHL, Embase and ASSIA databases were searched 2005-November 2024. Twenty-nine studies were included. Fifteen studies compared rural and urban populations, eleven urban only, two coastal urban and one rural. No studies considered the coastal context when examining place of death. 6,988,050 cancer and 3,517,909 dementia decedents were included across seventeen cancer studies, nine dementia, and three both. All studies were rated high quality. Rural, dementia decedents were more likely to die in residential care than urban residents, who were more likely to die in hospital. Large studies of cancer populations found trends towards home deaths for rural residents and hospital for urban, but this was inconsistent across countries. Thirteen studies reported factors associated with place of death for people with cancer, compared to four dementia. Hospital deaths appear more common in urban areas, with more home/care home deaths in rural areas. Coastal patterns are poorly described. Better understanding how these locations are associated with place of death, especially for people with dementia, is needed to guide more equitable, efficient service planning. Further work on associated factors will support a nuanced understanding of drivers of place of death.