Factors associated with the accomplishment of home death among patients receiving physician‐led home healthcare

Abstract

AimTo evaluate unique factors associated with home death in older Asian individuals who received physician‐led home healthcare.MethodsWe carried out a case–control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician‐led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death.ResultsA total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52–27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15–25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13–26.19).ConclusionsOlder age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525–531.

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

“…This also reduced the number of explanatory variables in the multivariable analyses. In contrast to two retrospective studies recently conducted in Japan, 17 , 18 we did not incorporate the preference of patients and their families as a variable predicting the location of their death. To investigate both the direct and indirect relationship between the factors at the introduction of home visits and death at home in the causal pathway of interest, 26 we excluded these as we considered them to be intermediate variables in determining the location of death, which were greatly influenced by the biomedical and psychosocial condition of the patient at the time of introduction and the surrounding social environment.…”

“…Of these, however, there was no prospective cohort study. In Japan recently several studies have reported the factors related to death at home 17,18 …”

“…In Japan recently several studies have reported the factors related to death at home. 17,18 However, these were also conducted in retrospective study designs. Furthermore, studies on how the likelihood of dying at home changes with the length of home care in patients under physician-led home visits like those in Japan remains to be seen.…”