Municipal Characteristics of In-Home Death Among Care-Dependent Older Japanese Adults.
Municipal Characteristics of In-Home Death Among Care-Dependent Older Japanese Adults.
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DOI：
10.1001/jamanetworkopen.2021.42273
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Tamiya N
中科院分区：
文献类型：
--
作者：
Abe K;Kawachi I;Taniguchi Y;Tamiya N
城市特征在多大程度上可以解释依赖照顾的老年人在生命末期留在家里的能力的地理差异？这项横断面研究通过对544例 836例死亡病例的多水平Logistic分析发现，死亡地点的变异中有7.2%与城市特征有关。特别是，更容易获得由市级医生、护士和护理人员提供的居家服务与更高的居家死亡概率相关。这些结果表明，市政一级的政策制定者应该确保提供足够的诊所、医生和护理人员提供居家服务，以满足希望在家中度过最后日子的依赖护理的老年人的偏好。提供居家和社区临终关怀已成为世界各地老龄人口的一个重要政策问题。尽管大多数患者表示希望在家中死亡(而不是在医院)，但在生命末期在家中死亡的比例仍然存在很大的地域差异。评估在日本依赖护理的老年人中，城市特征与死亡地点变化的关联。在这项使用多水平Logistic回归的横断面研究中，使用日本长期护理保险制度下的国家索赔数据进行了分析。研究人群包括2015年死亡的65岁及以上的长期护理保险受益人，不包括那些死于意外伤害等外部原因的人。数据分析从2021年1月1日至4月31日进行。根据行为模型，在个人和市政层面上的诱因、使能和需要因素。结果是个体是否在家中死亡。这项横断面研究分析了544例 患者(年龄中位数87[81-91]岁；女性300例 142例[55.1%])。家庭死亡比例为10.3%。在多水平零模型中，死亡地点的7.2%的方差与市级特征有关。与地方特征(2.7%)相比，市级特征与差异的关联性更大。当将促进因素(即医疗和长期护理资源)添加到模型中时，在市政一级观察到最大的比例变化(7.3%)。家庭死亡比例高的城市更有可能拥有更多的诊所、医生和护理人员提供家庭服务，而每人口的医院床位和长期护理设施工作人员的数量更少。在这项横断面研究中，城市特征解释了日本家庭死亡的地理差异的很大比例。这些结果表明，市政政策制定者需要确保提供足够的诊所、医生和护理人员提供居家服务，以满足希望在家中度过最后日子的依赖护理的老年人的偏好。这项横断面研究评估了在日本老年人中，市政特征是否与家庭内死亡与家庭外死亡有关。
To what extent can municipal characteristics explain geographic variation in the ability of care-dependent older people to stay at home at the end of life? This cross-sectional study with multilevel logistic analysis of 544 836 deaths found that 7.2% of the variance in place of death at the end of life was associated with municipal characteristics. In particular, higher accessibility to in-home services provided by physicians, nurses, and care workers at the municipal level was associated with a higher probability of in-home death. These results suggest that policy makers at the municipal level should ensure an adequate supply of clinics, physicians, and care workers providing in-home services to meet the preferences of care-dependent older people who wish to spend their final days at home. The provision of in-home and community end-of-life care has emerged as an important policy issue for aging populations around the world. Despite most patients expressing the wish to die at home (as opposed to in the hospital), substantial geographic variation persists in the prevalence of in-home death at the end of life. To assess the association of municipal characteristics with variation in the place of death among care-dependent older people in Japan. In this cross-sectional study using multilevel logistic regression, analyses were performed using national claims data under Japan’s long-term care insurance system. The study population included long-term care insurance beneficiaries 65 years and older who died in 2015, excluding those who died from external causes, such as unintentional injuries. Data analyses were conducted from January 1 to April 31, 2021. Predisposing, enabling, and need factors at the individual and municipal levels according to a behavioral model. The outcome was whether individuals died at home or not. This cross-sectional study analyzed 544 836 decedents (median [IQR] age, 87 [81-91] years; 300 142 [55.1%] female). The proportion of in-home deaths was 10.3%. In the multilevel null model, 7.2% of the variance in the place of death was associated with municipal-level characteristics. Municipal characteristics were associated with more of the variance than were prefectural characteristics (2.7%). The largest proportional change (7.3%) in variance at the municipality level was observed when enabling factors (ie, medical and long-term care resources) were added to the model. Municipalities with a high proportion of in-home death were more likely to have a higher supply of clinics, physicians, and care workers providing in-home services per population, as well as a lower number of hospital beds and long-term care facility workers per population. In this cross-sectional study, municipal characteristics explained a substantial proportion of the geographic variance in in-home death in Japan. These results suggest that municipal policy makers need to ensure an adequate supply of clinics, physicians, and care workers providing in-home services to meet the preferences of care-dependent older people who wish to spend their final days at home. This cross-sectional study assesses whether municipal characteristics are associated with in-home deaths vs deaths outside the home among older Japanese adults.
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影响因子：
3.1
作者：
Gomes B;Calanzani N;Gysels M;Hall S;Higginson IJ
通讯作者：
Higginson IJ
DOI：
10.1111/j.1532-5415.2005.53175.x
发表时间：
2005-03-01
影响因子：
6.3
作者：
Tsutsui, T;Muramatsu, N
通讯作者：
Muramatsu, N
影响因子：
4.7
作者：
Patrick, DL;Engelberg, RA;Curtis, JR
通讯作者：
Curtis, JR
影响因子：
2.9
作者：
Abe, Kazuhiro;Miyawaki, Atsushi;Tamiya, Nanako
通讯作者：
Tamiya, Nanako
影响因子：
2.8
作者：
Higginson, I J;Sen-Gupta, G J
通讯作者：
Sen-Gupta, G J