[Dying in Rhineland-Palatinate (Germany): preferred and actual place of death]

Background: Until now, no official statistics about the place of death in Germany exist.

Objectives: The aim of our study was to determine where people died in Rhineland-Palatinate (Germany) in 2008, and which place of death was preferred. We further aimed to identify influencing factors on dying at home vs. dying in an -institution.

Methods: Our cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate (Germany) that had died between May and August 2008. Relatives of these deceased persons received a questionnaire containing socio-demographic and health-specific questions.

Results: After removing duplicates, 4967 questionnaires were sent out. 3832 questionnaires were delivered and 1378 completed, leading to a response rate of 36.0%. 38.2% of the deceased died at home, 39.3% in a hospital, 13.4% in a nursing home, 7.5% in a palliative care facility and 1.6% elsewhere. 93.8% of the deceased who expressed a preference wanted to die at home. Altogether, 58.3% had their wish fulfilled. Suffering from cancer (aOR:1.30; 95% CI:1.01-1.68), social support (aOR being married:1.33; 95% CI:1.04-1.70; aOR having a non-/part-time working relative:1.71; 95% CI: 1.28-2.29), a high care level (aOR care level II:2.79; 95% CI: 2.06-3.79; aOR care level III: 4.96; 95% CI:3.40-7.24), and living in a rural municipality (aOR: 1.36; 95% CI:1.01-1.84) were factors favouring=BE; AE=favoring home death compared with institutional death.

Conclusion: Altogether, 4 of 10 patients who wanted to die at home could not die in their preferred place. Future studies should focus on the question as to what extent the strengthening of outpatient care structures, e. g., by introducing specialised=BE spezialized=AE outpatient palliative care, can allow more people to die at home.