Abstract
BackgroundJapan has promoted end-of-life care at home and in long-term care facilities, and the total proportion of in-hospital deaths has decreased recently. However, the difference in trends of in-hospital deaths by the cause of death remains unclear. We investigated the variation in trends of in-hospital deaths among older adults with long-term care from 2007 to 2017, by cause of death and place of care.MethodsUsing the national long-term care insurance registry, long-term care claims data, and national death records, we identified people aged 65 years or older who died between 2007 and 2017 and used long-term care services in the month before death. Using a joinpoint regression model, we evaluated time trends of the proportion of in-hospital deaths by cause of death (cancer, heart diseases, cerebrovascular diseases, pneumonia, and senility) and place of care (home, long-term care health facility, or long-term care welfare facility).ResultsOf the 3,261,839 participants, the mean age was 87.0 ± 8.0 years, and 59.2% were female. Overall, the proportion of in-hospital deaths decreased from 66.2% in 2007 to 55.3% in 2017. By cause of death, the proportion of in-hospital deaths remained the highest for pneumonia (81.6% in 2007 and 77.2% in 2017) and lowest for senility (25.5% in 2007 and 20.0% in 2017) in all types of places of care. The joinpoint regression analysis showed the steepest decline among those who died of senility, especially among long-term care health facility residents.ConclusionsThe findings of this nationwide study suggest that there was a decreasing trend of in-hospital deaths among older adults, although the speed of decline and absolute values varied widely depending on the cause of death and place of care.
Highlights
Japan has promoted end-of-life care at home and in long-term care facilities, and the total proportion of in-hospital deaths has decreased recently
From the 6,632,539 older adults who were eligible from the long-term care insurance (LTCI) registry during the period between 2007 and 2017, we uniquely identified 6,426,937 people (96.9%) using the four variables, and successfully linked 5,722,084 people (86.3%) with the national death records
The 24,079 patients who received LTCI services at multiple sites in the month before death were excluded in the analysis
Summary
Japan has promoted end-of-life care at home and in long-term care facilities, and the total proportion of in-hospital deaths has decreased recently. There is a rise in the proportion of older adult populations worldwide due to decline in fertility rates and extension of life expectancy [1] This makes where to provide end-of-life care a matter of global interest. The number of deaths in Japan is expected to increase from 1.3 million in 2017 to 1.6 million by 2030 [3, 6], and hospital bed capacity as a place of death is predicted to be in short supply [7, 8] To fill this gap, the Japanese government has, since 2006, promoted end-of-life care at home and at long-term care (LTC) facilities, by increasing the financial incentives for service providers who attend to patients’ deaths at home and at LTC facilities [9,10,11]
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