Place of death among Botswana's oldest old.

Botswana, a country in sub-Saharan Africa, has been in the midst of an HIV/AIDs pandemic that has halted its previously lengthening life expectancy trend. However, one group to escape immediate effects on falling life span is the oldest old age group (> 80 years). Their roles in the community due to the pandemic, however, have changed. Place of death is an important consideration in end-of-life care for older adults, and one which has been well studied in the Global North. The purpose of this article is to determine where Botswana's oldest old die (home or hospital), and to see whether cause of death, gender, or residence in a city, town, or rural area is associated with place of death. We use death certificate data from 2005 and 2006 to describe where the oldest old Batswana (the name for the people of Botswana) died, home or hospital. Two-thirds died at home. The mean age at death was 88.46 (+/- 6.21) years; more were female (56.9%); and of known causes of death, cardiovascular disease was the leading cause (16.8%). Most stated causes of death (62.4%) were listed as "unknown." Most oldest-old Batswana died in rural areas (70.1%), and in rural areas, proportionally more oldest old died at home compared to cities and towns. On multivariate analysis, being a woman > 80 years of age at death predicted home death. Future longitudinal study needs to determine preferences of place of death and the quality of death of Batswana > 80 years, especially women.