{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T20:11:37Z","timestamp":1780344697854,"version":"3.54.1"},"reference-count":57,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T00:00:00Z","timestamp":1575331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018270","name":"Health Service Executive","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100018270","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"\n Background:<\/ns3:bold>\n All countries face growing demand for palliative care services.\u00a0 Projections of need are essential to plan care in an era of demographic change.\u00a0\u00a0 We aim to estimate palliative care needs in Ireland from 2016 to 2046.\n <\/ns3:p>\n \n Methods:<\/ns3:bold>\n Static modelling of secondary data.\u00a0 First, we estimate the numbers of people in Ireland who will die from a disease associated with palliative care need.\u00a0 We combine government statistics on cause of death (2007-2015) and projected mortality (2016-2046).\u00a0 Second, we combine these statistics with survey data to estimate numbers of people aged 50+ living and dying with diseases associated with palliative care need.\u00a0 Third, we use these projections and survey data to estimate disability burden, pain prevalence and health care utilisation among people aged 50+ living and dying with serious medical illness.\n <\/ns3:p>\n \n Results:<\/ns3:bold>\n In 2016, the number of people dying annually from a disease indicating palliative care need was estimated as 22,806, and the number of people not in the last year of life aged 50+ with a relevant diagnosis was estimated as 290,185.\u00a0 Equivalent estimates for 2046 are 40,355 and 548,105, increases of 84% and 89% respectively.\u00a0 These groups account disproportionately for disability burden, pain prevalence and health care use among older people, meaning that population health burdens and health care use will increase significantly in the next three decades.\n <\/ns3:p>\n \n Conclusion:<\/ns3:bold>\n The global population is ageing, although significant differences in intensity of ageing can be seen between countries. Prevalence of palliative care need in Ireland will nearly double over 30 years, reflecting Ireland\u2019s relatively young population.\u00a0 People living with a serious disease outnumber those in the last year of life by approximately 12:1, necessitating implementation of integrated palliative care across the disease trajectory. Urgent steps on funding, workforce development and service provision are required to address these challenges.\n <\/ns3:p>","DOI":"10.12688\/hrbopenres.12975.1","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T11:25:08Z","timestamp":1575372308000},"page":"35","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Population-based palliative care planning in Ireland: how many people will live and die with serious illness to 2046?"],"prefix":"10.12688","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8501-6500","authenticated-orcid":false,"given":"Peter","family":"May","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0565-9571","authenticated-orcid":false,"given":"Bridget M.","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0885-5754","authenticated-orcid":false,"given":"Charles","family":"Normand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene J.","family":"Higginson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9336-8124","authenticated-orcid":false,"given":"Rose Anne","family":"Kenny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-260X","authenticated-orcid":false,"given":"Karen","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2019,12,3]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"e883-e892","DOI":"10.1016\/S2214-109X(19)30172-X","article-title":"The Escalating Global Burden of Serious Health-Related Suffering: Projections to 2060 by World Regions, Age Groups, and Health Conditions.","volume":"7","author":"K Sleeman","year":"2019","journal-title":"Lancet Glob Health."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"117-171","DOI":"10.1016\/S0140-6736(14)61682-2","article-title":"Global, Regional, and National Age-Sex Specific All-Cause and Cause-Specific Mortality for 240 Causes of Death, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013.","volume":"385","year":"2015","journal-title":"Lancet."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"587-589","DOI":"10.1016\/S0140-6736(14)61596-8","article-title":"Multimorbidity--older Adults Need Health Care That Can Count Past One.","volume":"385","author":"S Banerjee","year":"2015","journal-title":"Lancet."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"747-755","DOI":"10.1056\/NEJMra1404684","article-title":"Palliative Care for the Seriously Ill.","volume":"373","author":"A Kelley","year":"2015","journal-title":"N Engl J Med."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12904-017-0220-1","article-title":"The Provision of Generalist and Specialist Palliative Care for Patients With Non-Malignant Respiratory Disease in the North and Republic of Ireland: A Qualitative Study.","volume":"17","author":"C Mc Veigh","year":"2017","journal-title":"BMC Palliat Care."},{"key":"ref-6","article-title":"WHO Definition of Palliative Care","year":"2017"},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"2104-2114","DOI":"10.1001\/jama.2016.16840","article-title":"Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.","volume":"316","author":"D Kavalieratos","year":"2016","journal-title":"JAMA."},{"key":"ref-8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2925","article-title":"Effect of Specialist Palliative Care Services on Quality of Life in Adults With Advanced Incurable Illness in Hospital, Hospice, or Community Settings: Systematic Review and Meta-Analysis.","volume":"357","author":"J Gaertner","year":"2017","journal-title":"BMJ."},{"key":"ref-9","article-title":"Role Delineation Framework for Adult Palliative Care Services.","year":"2015"},{"key":"ref-10","article-title":"Global Atlas of Palliative Care at the End of Life","author":"S Connor","year":"2014"},{"key":"ref-11","article-title":"The Quality of Death Index: Ranking palliative care across the world","year":"2015"},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12916-017-0860-2","article-title":"How Many People Will Need Palliative Care in 2040? 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:35:11Z","timestamp":1750224911000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,3]]},"references-count":57,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.12975.1","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.14060.r26992","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.14060.r27048","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.14060.r26992","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/hrbopenres.14060.r27048","asserted-by":"object"}],"is-version-of":[{"id-type":"doi","id":"10.12688\/hrbopenres.12975.2","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,3]]},"assertion":[{"value":"Approved, Approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.14060.r27048, Staffan Lundstr\u00f6m, Department of\u00a0Palliative\u00a0Medicine, Stockholms Sjukhem Foundation, Stockholm, 08 Jan 2020, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1#referee-response-27048","order":0,"name":"referee-response-27048","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Peter May<\/b>; \nPosted: 21 Jan 2020<\/i>; We are grateful to the reviewer for their report. Changes were minor.  For each reviewer comment requiring action, we use the notation [R1\/C1, R1\/C2, etc], where R indicates which reviewer and C numbers each comment.  We mark our responses to each comment >>>.\nR1\/C1 <\/b>For readers outside of Ireland it would be valuable if the authors provided information about the current number of inhabitants in Ireland in Methods\/Setting.>>>Added to Methods>Setting:In 2015, the baseline year for our data, the estimated population was 4.7million people with 30,127 (0.006%) recorded deaths.\nR1\/C2 <\/b>Details on TILDA are provided in references, but I suggest the authors in the text provide the number of participants they base analyses 2 and 3 on, namely Wave 3 (2014) and the end-of-life interviews Waves 1-5. This would facilitate the assessment of validity of the findings.>>>Sample sizes added to Methods>Data sources for Wave 3 (N=6,381) and end-of-life interview (N=716).","URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1#referee-comment-3121","order":1,"name":"referee-comment-3121","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.14060.r26992, Anne Finucane, Marie Curie Hospice Edinburgh, Edinburgh, 15 Jan 2020, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1#referee-response-26992","order":2,"name":"referee-response-26992","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Peter May<\/b>; \nPosted: 21 Jan 2020<\/i>; We are grateful to the reviewer for their detailed and thoughtful report.  We have made a number of changes to the manuscript following these comments.  The most substantive change is the addition of a new Figure comparing Ireland\u2019s population age distribution to the rest of the European Union (Figure 1, version 2).  We also add clarifying text on Ireland\u2019s population ageing and the interpretation of our main results tables.For the most part changes were minor.  Each specific change is documented in responses to the relevant reviewer report.  For each reviewer comment requiring action, we use the notation [R1\/C1, R1\/C2, etc], where R indicates which reviewer and C numbers each comment.  We mark our responses to each comment >>>.\nR2\/C1<\/b> For those outside of Ireland, perhaps clarify if data refers to the island of Ireland or Republic of Ireland.>>>Abstract changed to Republic of Ireland to avoid confusion. >>>In the main manuscript we continue to use \u2018Ireland\u2019 and provide the following explanation under Methods>Setting:[Ireland] is sometimes called the Republic of Ireland to distinguish the sovereign state from the island of Ireland (incorporating Northern Ireland), but the country\u2019s official name is Ireland and we use this form throughout. \nR2\/C2<\/b> Please clarify whether the study is specific to the Republic of Ireland or the whole island of Ireland?  >>>See R2\/C1. \nR2\/C3<\/b> What is the population and number of deaths in recent year(s)?>>>Added to Methods>SettingIn 2015, the baseline year for our data, the estimated population was 4.7million people with 30,127 (0.006%) recorded deaths. \nR2\/C4<\/b> Is it possible to add a comparison graph comparing age distribution of the Irish population (current and projected if available) with that of the EU or other relevant comparison countries (e.g. England\/Wales; Scotland).  This might provide useful detail on the extent to which the age profile of Ireland\u2019s population differs from other high-income countries. This could be presented in the Introduction, or in the Methods (setting) section. >>>We have added a new Figure 1 comparing Ireland\u2019s population distribution with the rest of the EU-28.  Data are from the last Eurostat Census (2011) and are added to the OSF underlying data appendices. \nR2\/C5<\/b> Data sources: Please reference data sources used in the first paragraph under Data sources. >>>References added.\nR2\/C6<\/b> Perhaps clarify what are \u2018exposure\u2019 variables where they are first mentioned.>>>We have reworded the end of paragraph 2 in Methods>Data sources, so \u2018exposure variables\u2019 are now mentioned for the first time in their own sub-section, where they are defined. \nR2\/C7<\/b> Please add content to reference 34 link \u2013 further details could not be accessed.  >>>This reference mistakenly redirects the reader to the OSF registration, not the OSF content. We have asked editorial to correct.  We have also revised how appendices are described in the text so that readers know which specific file to open. \nR2\/C8<\/b> Please check page 4, last paragraph \u2013 last sentence \u2013 should this say ICD-10 codes instead of CSO codes? >>>Revised to:For further details on concordance between the CSO\u2019s use of ICD-10 codes\u2026 \nR2\/C9<\/b> In analysis 2 and 3, please justify why those \nliving <\/i>with cancer (as opposed to those who died with cancer) can be classified as having a disease associated with palliative care need, given increased survivorship in those with a cancer diagnosis.>>>Explanation provided in Introduction>Rationale and aim:policy and clinical guidelines increasingly recommend palliative care across the trajectory of serious disease, meaning that those dying from these diseases are only a subset of the overall population health need (refs). To inform decision-making in policy and practice, including the targeting of interventions to those who benefit, groups cannot be defined by their characteristics at death and instead must be identified prospectively on the basis of clinical and other relevant factors (refs). \nR2\/C10<\/b> Please add detail on step-by-step calculations for Analysis 2 & 3 \u2013 reference 34 contains no data.>>>See R2\/C7. \nR2\/C11 <\/b>Please recheck percentages in Results, paragraph 2.  A 30-year increase of 68% is reported.  Is this correct?  Should this be 61% over 31 years? Please clarify.  >>>We replaced the 2015 figure with the 2016 figure, and this is a 30-year change. \nR2\/C12<\/b> Please provide detail on how the increase in absolute numbers of deaths from a disease associated with palliative care need was calculated (78% to 84%) as the percentages are not presented in the table. Please recheck all percentages reported. Is 84% correct?>>>These numbers are correct and correspond to the relevant cells.  We have added more explanatory text prior to Table 2 to assist interpretation:We quantify changing need over time in three ways in Table 2: absolute number of projected deaths with palliative care need in a given year (denoted n \ny<\/sub>), this absolute number as a proportion of all projected deaths in a given year (denoted p(N \ny<\/sub>)), and this absolute number relative to absolute number of projected deaths with palliative care need at baseline in 2016 (denoted \u2018Rate of change index\u2019). \nR2\/C13<\/b> Please check first line which states that the number of people in Ireland dying from a disease associated with palliative care need is estimated to increase between 68% to 84%.   However in the results section, end of paragraph 3, the percentages mentioned are 78% to 84%.  Please clarify. >>>As well as changes under R2\/C12, we revise the opening section of the discussion as follows:The number of people in Ireland dying from a disease associated with palliative care need is estimated to increase 68% between 2016 and 2046 if levels of need stay constant.  Under assumptions of changing need, increases are estimated in the range 78\u201384% depending on projection method employed \nR2\/C14 <\/b>Please double-check Etkind\n et al. <\/i>study for equivalent estimates for England and Wales (43% or 47% in Etkind \net al<\/i>?).>>>Our 43% comes from the abstract (an increase of 161842 to 537240) but in their Discussion they do report 47% which can be sourced to a different projection method (which gives an increase of 175,336 to 550,734).  Since we also used this latter method, you are correct that this is a valid comparison.  43% has been changed to 47% at all points. \nR2\/C15 <\/b>Please elaborate on how Ireland\u2019s younger population might account for the greater increases in palliative care need in Ireland compared with England and Wales.  This is not totally clear given that most of the increases in both studies comes from increases in the number of people dying aged 85+>>>Following R2\/C4 above, we have added Figure 1 to illustrate this point and also this explanatory text (Methods>Setting):Compared to the other 27 countries in the European Union (EU), Eurostat\u2019s 2011 Census data show that Ireland has a higher proportion of its population for each age group under the age of 40.  The EU average is higher for each age group over 40.  Therefore Ireland can be seen as relatively early in the current trend for global ageing: in 20-30 years\u2019 time it will have proportionally larger numbers moving into older age and retirement compared to other high-income countries who are already experiencing these trends 19 .  Need for geriatric and palliative care will rise accordingly as the population ages. \nR2\/C16<\/b> Limitations \u2013 last paragraph \u2013 should Table 1 read Table 2? >>>Correct. We have changed. \nR2\/C17 <\/b>\u201c\nand that endeavours to close the policy-implementation gap<\/i>\u201d. Is there something missing from this sentence? >>>Revised for clarity:There is a growing literature recognising that policy enactment does not translate directly to policy success. Rather, implementation and continued support for the policy after enactment are essential.    \nR2\/C18<\/b> As above, please recheck data (84% increase?). >>>Please see R2\/C12 and R2\/C13.","URL":"https:\/\/hrbopenresearch.org\/articles\/2-35\/v1#referee-comment-3122","order":3,"name":"referee-comment-3122","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"\u2018The UP Study - Understanding Inequalities in Palliative Care for Older People and Providing for Future Need\u2019; PI: Karen Ryan; Health Service Executive Healthy Ageing Awards 2017. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}