Place of death trends among patients with dementia in Japan: a population-based observational study

Koyama, Toshihiro; Sasaki, Masahide; Hagiya, Hideharu; Zamami, Yoshito; Funahashi, Tomoko; Ohshima, Ayako; Tatebe, Yasuhisa; Mikami, Naoko; Shinomiya, Kazuaki; Kitamura, Yoshihisa; Sendo, Toshiaki; Hinotsu, Shiro; Kano, Mitsunobu R.

doi:10.1038/s41598-019-56388-w

Cited by 17 publications

(17 citation statements)

References 14 publications

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“…In addition, despite the increase in nursing home mortality ratio, a decrease was observed in home deaths. 19 In a study conducted by Reyniers et al, 20 examining deaths due to dementia in 14 countries, remarkable differences between countries were observed in places of death.…”

Section: Discussionmentioning

confidence: 98%

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

et al. 2021

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Background End-of-life care has become an important public health issue in recent years. Place of death is a major component of end-of-life care. Despite attempts to improve end-of-life care, there has not been published any data about place of deaths in Turkey. Aim: This retrospective, cross-sectional study investigates the place of death and trends over the years in geriatric age groups in Turkey. Methods: Patients who were admitted to geriatric outpatient clinic of a university hospital during a 7-year period were included. Place and date of death information were received from the death notification system and recorded as hospital or out-of-hospital death. Demographic and clinical data were collected from the hospital information system. Deaths occurring after March 1, 2020 were not included to eliminate the effect of coronavirus disease-2019 pandemic. Results: A total of 4025 (20.7%) patients were determined to be dead. Approximately three-quarters of deaths (73.0%) occurred in hospital. The number of deaths reported from nursing homes was only 13 (3.0%). Patients with dementia less frequently died in hospital, however, it was not statistically significant (12.4% vs 14.7%, P = .05). The prevalence of death in hospital was significantly higher in patients with chronic renal failure (3.1% vs 1.7%, P = .02). The presence of comorbid conditions such as heart failure, cerebrovascular disease, Parkinson's disease, chronic obstructive pulmonary disease/asthma, and cancer did not affect the place of death ( P = .24, .21, .24, .51, and .18). Out-of-hospital mortality increased with advanced age ( P < .001). No significant difference was found in the place of death over the years ( P = .41). Conclusion: To the best of our knowledge, this is the first study examining the place of death in Turkey, an aging country. Our results may help to establish policies about end-of-life care in elderly people to improve quality of life by using resources effectively.

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Section: Discussionmentioning

confidence: 98%

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

et al. 2021

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“…3 Alice Ho Miu Ling Nethersole Charity Foundation, Hong Kong, Hong Kong. 4 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.…”

Section: Abbreviationsmentioning

confidence: 99%

“…The rapid growth of the elderly population and increased prevalence of chronic diseases not only drive the demand for long-term care but also influence the place of death. Population-based studies have shown that while the proportion of hospital deaths has declined in the past few decades, the proportions of care and nursing home deaths have increased [2][3][4]. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs.…”

Section: Introductionmentioning

confidence: 99%

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

2021

BMC Palliat Care

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Background The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

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“…Both reforms were characterized by integrated measures across health and social care for all older adults at the community level, which also included changes in end-of-life policies [ 28, 29 ]. Koyama et al [ 11 ] who studied location of death of persons with dementia in Japan over the period 1999–2016 found that the peak of hospital deaths was in 2005 and declined consistently after, while nursing home deaths steadily increased. Further research evaluating previous policy reforms on location of death could contribute to evidenced-based end-of-life policies.…”

Section: Discussionmentioning

confidence: 99%

“…Important pillars of the Orange Plan included 1) create a widespread, standardized dementia care pathway; 2) improve community-based healthcare services; 3) strengthen family support in communities; 4) accelerate the development of more health care staff providing long-term care; and 5) facilitate end-of-life care in group homes [ 10 ]. Koyama et al [ 11 ] found that since 2005 Japanese proportions of hospital death gradually decreased over time for the total population while nursing home deaths increased. Nakanishi et al [ 12 ] showed that after the introduction of the Orange Plan, persons with dementia were still more likely to die in a hospital, compared to nursing home and home.…”

Section: Introductionmentioning

confidence: 99%

Japanese National Dementia Plan Is Associated with a Small Shift in Location of Death: An Interrupted Time Series Analysis

Wammes

Nakanishi

Steen

et al. 2021

JAD

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Background: Japan has one of the highest percentages of persons with dementia and hospital deaths in the world. Hospitals are often not equipped to handle the care complexity required for persons with dementia at the end of life. The National Dementia Orange plan aimed to decrease hospital deaths by expanding time in the community. Objective: The aim of this study is to evaluate whether the National Dementia Orange Plan is associated with a decrease in hospitals deaths for persons with dementia. Methods: We used quarterly, cross-sectional, national death certificate data consisting of the total Japanese dementia population 65 years and older, spanning a period from 2009 to 2016. The primary outcome was quarterly adjusted relative risk rates (aRRR) of dying in hospital, nursing home, home, or elsewhere. An interrupted time series analysis was performed to study the slope change over time. Analyses were adjusted for sex and seasonality. Results: 149,638 died with dementia. With the implementation of the Orange Plan, death in nursing home (aRRR 1.08, [1.07–1.08], p < 0.001) and elsewhere (aRRR 1.05, [1.05–1.06], p < 0.001) increased over time compared to hospital death. No changes were found in death at home. Conclusion: This study provides evidence that the National Dementia Orange plan was associated with a small increase in death in nursing home and elsewhere. Hospital death remained the primary location of death. End-of-life strategies should be expanded in national dementia policies to increase aging in the community until death.

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Place of death trends among patients with dementia in Japan: a population-based observational study

Cited by 17 publications

References 14 publications

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

Japanese National Dementia Plan Is Associated with a Small Shift in Location of Death: An Interrupted Time Series Analysis

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