Factors associated with home death for individuals who receive home support services: a retrospective cohort study

Abstract

ObjectivesTo determine the factors associated with a home death among older adults who received palliative care nursing home services in the home.MethodsThe participants in this retrospective cohort study were 151 family caregivers of patients who had died approximately 9 months prior to the study telephone interview. The interview focused on the last year of life and covered two main areas, patient characteristics and informal caregiver characteristics.ResultsOdds ratios [OR] and 95% confidence intervals [95% CI] were used to determine which of the 15 potential informal caregiver and seven patient predictor variables were associated with dying at home. Multivariate analysis revealed that the odds of dying at home were greater when the patient lived with a caregiver [OR = 7.85; 95% CI = (2.35, 26.27)], the patient stated a preference to die at home [OR= 6.51; 95% CI = (2.66,15.95)], and the family physician made home visits [OR = 4.79; 95% CI = (1.97,11.64)]. However the odds were lower for patients who had caregivers with fair to poor health status [OR = 0.22; 95% CI = (0.07, 0.65)] and for patients who used hospital palliative care beds [OR = 0.31; 95% CI = (0.12, 0.80)].DiscussionThe findings suggest that individuals who indicated a preference to die at home and resided with a healthy informal caregiver had better odds of dying at home. Home visits by a family physician were also associated with dying at home.

Can This Patient Be Discharged Home? Factors Associated With At-Home Death Among Patients With Cancer

“…Patients with cancer are more likely to die at home if the caregiver has access to more intensive social support. [43][44][45][46][47][48][49][50] In our study, the Zarit's interview was not highly predictive of place of death; however, the subjective perception of support was highly predictive of place of death. Thus, in clinical practice, it may be easier to ask caregivers about their perceived burden and level of support than to conduct a lengthy interview.…”

“…31,43, 44 The amount of support that caregivers receive and the caregiver's perceived burden are central issues. Patients with cancer are more likely to die at home if the caregiver has access to more intensive social support.…”

Associations between home death and GP involvement in palliative cancer care

“…7,[20][21][22] Contrary to these studies, the model was adjusted by including time at home in the palliative period. This was because dying at home often demands more home visits and more home care, and the patient has to be at home to receive these visits.…”

Burdens of Family Caregiving at the End of Life

“…Clinically e ective practice support tools in palliative home care are warranted to identify family caregiver needs and to ensure that patients and their family caregivers have a choice about where care is provided. The aging population, the growing number of Canadians diagnosed with chronic life-limiting illness, and the fact that a large majority of Canadians report that they prefer to spend their nal days at home [1,2,3] are converging to prompt government policy to press for more and better care of dying people in the community [4]. Patients' ability to be cared for and to die at home, however, is heavily dependent upon the e orts of family caregivers [5].…”