Place of death associated with types of long-term care services near the end-of-life for home-dwelling older people in Japan: a pooled cross-sectional study
Place of death associated with types of long-term care services near the end-of-life for home-dwelling older people in Japan: a pooled cross-sectional study
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DOI：
10.1186/s12904-020-00622-0
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发表时间：
2020-08-09
影响因子：
3.1
通讯作者：
Tamiya, Nanako
中科院分区：
文献类型：
--
作者：
Abe, Kazuhiro;Miyawaki, Atsushi;Tamiya, Nanako
许多老年人希望死在家里。然而，老年人希望的死亡地点与他们实际死亡的地方之间仍然存在巨大差距。我们的目的是评估居家老年人在生命结束时使用的每种类型的长期护理（LTC）服务与死亡地点之间的关系。方法采用死亡时的汇总横断面研究进行分析。参与者包括2008年1月至2013年12月期间去世的65岁及以上的日本长期护理保险受益人，但不包括因外部因素死亡的人和在死亡时使用住宿服务的人。我们进行了多变量泊松回归分析，对潜在的混杂因素进行了稳健的标准误差调整，并检查了家庭居住接受者使用每种类型的LTC服务之间的关联，包括家庭服务、日间服务和短期住宿服务，交互项为死亡时间（暴露）和家庭死亡（结果）。我们使用标准边缘化计算了为居家受助人提供LTC服务的每种组合模式的调整后家庭死亡概率。结果：我们分析了2,035,657名受益人。使用家庭服务、日间服务和短期住宿服务与家庭死亡的可能性增加有关；居家服务的事故率比（IRR）为13.40(95%可信区间（CI）： 13.23-13.57)，日间服务的IRR为6.32(6.19-6.45)，短期服务的IRR为1.25（1.16-1.34）。与只使用日间或短期住宿服务的人相比，使用日间或短期住宿服务的人在家死亡的可能性更高。结论：我们证明，与没有使用LTC服务的老年人相比，在生命末期使用LTC服务的老年人在家中死亡的可能性更高。我们的研究结果可以澄清提供和整合这些服务的重要性，以支持希望在家中死亡的护理接受者以及他们的非正式护理者的利益。
Background Many 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. Methods A 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. Results We 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. Conclusions We 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.