More and more people are developing dementia over their life course, partially because of the increasing ageing of the population and rising life expectancies. This phenomenon raises questions about health and care, in general, but specifically the impact of the shifting morbidity profiles at the end of life. A new study by Gabriele Doblhammer, Thomas Fritze, Constantin Reinke and Anne Fink (University of Rostock and German Center for Neurodegenerative Disease, Bonn) investigated whether, at the end of life, dementia will become more common in the future or whether other diseases, such as cancer, will come to the fore. To do so, they used data from the population projections of the German Federal Statistical Office, the Human Mortality Database and the largest public health insurer in Germany Allgemeine Ortskrankenkasse (AOK) to create projections of the health profiles at the time of death for those over the age of 70.
It turns out that dementia at the end of life has already become widespread, especially among the over-80-year-olds, with more than half of those who died in this age group having previously received a dementia diagnosis. While overall dementia incidence is increasing due to population ageing and gains in life expectancy, studies indicate that age-specific incidence has actually declined over time and that dementia diagnoses were shifted into higher ages closer to death.
The study shows dementia is currently the most common disease at the time of death among women over 70 in Germany, while it is only in fifth place among men where ischaemic heart disease (IHE) leads. As of now, IHE, cerebrovascular diseases, as well as cancer and chronic pulmonary disease (COPD), are each among the most common diseases at the time of death, albeit in a different order of significance for women and men. If these disease profiles remain constant, then projections show that by 2060 dementia will become second in men over 70 years of age after IHE.
However, when factoring in the recent trends in morbidity (e.g. rising incidences of certain cancers, such as: lung, breast and pancreatic cancers in women and prostate, pancreatic and lung cancers in men; and the decline in mortality from many cancers), the most prevalent disease at the time of death in the middle of the century will be cancer for both men and women.
The authors of the study suggest that, in addition to research on causes of death, more research and projections of the morbidity profile at the time of death is needed for us to better prepare for future needs of people towards the end of their lives. These insights into the preceding health at the time of death are an important basis for future health policy decisions, the allocation of health care resources and the support of formal and informal care providers.