Original ResearchPopulation, mortality and place of death in Germany (1950–2050) – Implications for end-of-life care in the future
Introduction
As in many parts of the world, populations in Europe are ageing and are expected to age further in the future.1 This is mainly due to longer life expectancy and low fertility.1 In 2009, 17.2% of the European population was aged ≥ 65 years; this age group is expected to account for 28.8% of all European citizens in 2050, with those aged ≥ 80 years projected to almost triple to 56.6 million.2 The rapid ageing in Europe poses an urgent public health problem of where and how best to care for increasing numbers of older people towards the end of life. Older people have special needs because they are more often affected by multiple medical problems, at greater risk of adverse drug reactions, and more often superimposed by mental impairment.3 In addition, the elderly are at high risk of poor symptom control (particularly for pain), and often experience a lack of information and involvement in decision-making (e.g. regarding end-of-life issues).4, 5
Germany is currently the third oldest country in the world, ageing ahead of all European countries apart from Italy.6, 7 There are ongoing debates about how this process has changed German society, and large investments are underway to develop ways to face the challenges of providing healthcare for older citizens.8, 9 Indeed, most of the healthcare provided to older people takes place during their last year of life.10 However, little is known about the extent to which future demographic changes will impact on end-of-life care needs. This is important to decide the capacity levels required and where to allocate resources with a view to best support people where they are and to enable them to die where they wish.
This study aimed to analyse population, mortality and place of death (PoD) trends in Germany since 1950, and to project future mortality by PoD until 2050.
Section snippets
Design, setting and timeframe
Secondary analysis of national data from the Federal Statistical Office (FSO) in Germany was undertaken. The unit of analysis was the whole of Germany, comprising the former Eastern part (German Democratic Republic) and the former Western part (Federal Republic of Germany). The analysis of past trends included years between 1950 and 2009 (before and after the reunification of the Eastern and Western parts in 1990).
Population and vital statistics
National data on the German resident population, births and deaths (1950–2009)
Population
From 1950 to 2002, the German resident population increased steadily by 19.0%, from 69.3 to 82.5 million. From 2002 onwards, the number of residents started to decrease (82.0 million in 2009). Several demographic changes contributed to this decrease, mainly the fall in the number of births and the rise in the number of deaths (Fig. 1).
Between 1950 and 1972, the annual number of births was always higher than the number of deaths, particularly during the ‘baby-boom’ in the 1960s. This changed in
Discussion
To the authors' knowledge, this is the first analysis of future mortality by PoD in Germany. The number of deaths is predicted to increase substantially until 2050. German citizens will die increasingly at advanced ages, and nearly half are expected to continue to die in hospitals. At the same time, the resident population is shrinking, with fewer young people to care for a greater number of older people. Ensuring that people live well towards the end of life is therefore increasingly important
Acknowledgements
The authors wish to thank the staff of the FSO in Germany for their help and advice to identify the appropriate data.
Ethical approval
Not required.
Funding
This work was supported by the Dr. Werner Jackstädt Foundation in Germany (Grant Number S 134–10.040) without involvement in study design, data collection, analysis, interpretation of the data, writing the report or submission of the study.
Competing interests
None declared.
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