Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan

Abstract

Background The Japanese government is promoting physician‐led home visits as well as end‐of‐life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years. Objectives To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. Methods This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed‐up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home. Results We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person‐years (95% confidence interval 116.1–163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full‐time caregiver increased the likelihood of deaths at home relative to deaths at other locations. Conclusions Of deceased patients, only one‐third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005–1012.

Relationship of life expectancy with quality of life and health-related hope among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

“…Third, although this study assessed the presence of family members, it was not possible to assess whether family members lived with the patient or were caregivers. Since it was reported that the presence of family caregivers or full-time caregivers influences end-of-life care at home [ 34 ], future research is needed to investigate the details concerning family members. Fourth, although our previous study found that the proportion of patients who discussed advance care planning with their physicians was 29% [ 22 ], we did not examine whether the physicians informed them about their life expectancy, and thus could not assess its impact on patient’s HR-Hope and QOL-HC scores.…”