Factors facilitating home death in non‐cancer older patients receiving home medical care

Abstract

Aim: To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners.Methods: A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death.Results: Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths.Conclusions: Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death.

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

“…Interestingly, rather than the place preferred for death by the patient, preferences of the family members was associated with the actual place of death in the present study, similar to a previous Japanese report. 26 In contrast with the findings from Japanese studies, including ours, many Western studies reported that patients' preferred place to die was the more strongly associated factor of home death than the family members' preferences for place of death. 27 This difference in the predominance of the preferable place of death might be driven by cultural differences between Asian and Western cultures.…”

Future Research in General Medicine Has Diverse Topics and is Highly Promising: Opinions Based on a Questionnaire Survey

“…Patients are treated in their everyday living environment, and close communication with patients is maintained. Under these circumstances, research on end-of-life care at home, 33 problems in community healthcare, 34 and medication usage are being actively conducted in the field of general medicine to provide more valuable healthcare services within the context of patients’ needs and limited healthcare resources. 35 Additionally, community medicine-based education is important in clinical education, 36 and therefore many studies on education in community medicine have also been conducted.…”

Patients’ and Relatives’ Preferences for a Palliative/Oncology Day Ward and Out-of-Hours Telemedicine—An Interpretive Description

“…Family involvement is considered one of the bedrocks of palliative care and families play a very important role in caring for palliative patients in the home. Previous studies have found that cohabitation is associated with dying at home and that family preferences play a role in facilitating home deaths [ 27 , 28 ]. Therefore, patient preferences will be influenced by relatives’ preferences and whether or not patients live alone or together with relatives will affect patient preferences.…”