Palliative care service use by older people: Time trends from a mortality follow

The need for increased use and timely initiation of palliative care for all people, not just those who die with cancer, has been advocated worldwide over the past decade. To investigate whether there has been a time trend in the use of palliative care services and the timing of their initiation for older people. Mortality follow-back survey among general practitioners in a nationally representative Sentinel Network in 2005–2010, 2013 and 2014 in Belgium. Of all their patients who died non-suddenly aged 65+？years, general practitioners reported sociodemographic and clinical data, use of any of the palliative care services available in Belgium and when the first of these services was initiated. General practitioners identified 5344 deaths. Overall, palliative care service use increased from 39% in 2005 to 63% in 2014 (p？<？0.001). The use of a reference person for palliative care in a care home increased from 12% to 26% (p？<？0.001) and of a palliative homecare team from 14% to 17.5% (p？<？0.01), but hospital-based palliative care services did not increase. Controlling for sociodemographic characteristics, no differences were obtained over time in the proportion of cancer/non-cancer patients for whom they provided care. The timing of initiation of palliative care services remained unchanged at a median of 15？days before death. Palliative care service use has increased mostly in care homes, possibly as a result of policy changes, while hospital-based palliative care services lag behind. Contrary to recommendations, access for non-cancer patients may remain difficult and palliative care is often initiated late in the disease trajectory