Abstract
BackgroundMany older people wish to die at home. However, there is still a huge gap between the place where older adults wish to die and the place where they, in fact, do die. We aimed to assess the association between each type of long-term care (LTC) services that home-dwelling older individuals utilized at their end of life and place of death.MethodsA pooled cross-sectional study at the point of death was used for the analysis. Participants included beneficiaries of long-term care insurance in Japan, aged 65 years and above, who passed away between January 2008 and December 2013, excluding those who died due to external factors and those who were using residential services at their time of death. We conducted a multivariate Poisson regression analysis with robust standard errors adjusting for potential confounders and examined the association between the use of each type of LTC service for home-dwelling recipients, including in-home services, day services, and short-stay services, with the interaction terms being time of death (exposure) and home death (outcome). We calculated the adjusted probability of home deaths for each combination pattern of LTC services for home-dwelling recipients using standard marginalization.ResultsWe analyzed 2,035,657 beneficiaries. The use of in-home services, day services, and short-stay services were associated with an increased probability of home deaths; the incident rate ratio (IRR) was 13.40 (with a 95% confidence interval (CI): 13.23–13.57) for in-home services, the IRR was 6.32 (6.19–6.45) for day services, and the IRR was 1.25 (1.16–1.34) for short-stay services. Those who used day or short-stay services with in-home services exhibited a higher probability of home deaths than those who used only day or short-stay services.ConclusionsWe demonstrated that home-dwelling older persons who used LTC services near end-of-life had a higher probability of home deaths as compared to those who did not. Our findings can clarify the importance of providing and integrating such services to support care recipients who wish to die at home as well as for the benefit of their informal caregivers.
Highlights
Many older people wish to die at home
The proportion of home deaths to all deaths was approximately 14% annually, and the number of older people who were ending their lives in long-term care (LTC) facilities and qualified nursing homes was increasing (Table 2 and Additional Table 1)
The results suggest that the necessity of the items within each LTC service type for home-dwelling recipients is diverse for care recipients and their caregivers staying at home until death
Summary
Many older people wish to die at home. In Japan, a nationwide survey conducted in 2012 revealed that older people over the age of 55 were more likely to expect to spend their life’s last moments at home instead of hospitals and facilities; 54.6% wanted to die at home [4]. The proportion of home deaths had reduced to 13.2% of all deaths in 2017, and the proportion of hospital deaths increased to 73.0% in the same year [5]. Given these gaps between the ideal and reality regarding place of death, it is essential to investigate the factors promoting the ability to experience a home death
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