Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.
PLoS One. 2019 Apr 18;14(4):e0215566. doi: 10.1371/journal.pone.0215566. eCollection 2019.
Many middle- and high-income countries face the challenge of meeting preferences for home deaths. A better understanding of associated factors could support the design and implementation of policies and practices to enable dying at home. This study aims to identify factors associated with the place of death in Singapore, a country with a strong sense of filial piety.
SETTINGS/PARTICIPANTS: A retrospective cohort of 62,951 individuals (≥21 years old) who had died from chronic diseases in Singapore between 2012-2015 was obtained. Home death was defined as a death that occurred in a private residence whereas non-home deaths occurred in hospitals, nursing homes, hospices and other locations. Data were obtained by extracting and linking data from five different databases. Hierarchical multivariable logistic regression models were used to examine the effects of individual, clinical and system factors sequentially.
Twenty-eight percent of deaths occurred at home. Factors associated with home death included being 85 years old or older (OR 4.45, 95% CI 3.55-5.59), being female (OR 1.21, 95% CI 1.16-1.25), and belonging to Malay ethnicity (OR 1.91, 95% CI 1.82-2.01). Compared to malignant neoplasm, deaths as a result of diabetes mellitus (OR 1.93, 95% CI 1.69-2.20), and cerebrovascular diseases (OR 1.28, 95% CI 1.19-1.36) were also associated with a higher likelihood of home death. Independently, receiving home palliative care (OR 3.45, 95% CI 3.26-3.66) and having a documented home death preference (OR 5.08, 95% CI 3.96-6.51) raised the odds of home deaths but being admitted to acute hospitals near the end-of-life was associated with lower odds (OR 0.92, 95% CI 0.90-0.94).
Aside from cultural and clinical factors, system-based factors including access to home palliative care and discussion and documentation of preferences were found to influence the likelihood of home deaths. Increasing home palliative care capacity and promoting advance care planning could facilitate home deaths if this is the desired option of patients.
许多中高收入国家都面临着满足人们在家中去世偏好的挑战。更好地了解相关因素可以支持制定和实施政策和实践，以实现在家中去世。本研究旨在确定与新加坡死亡地点相关的因素，新加坡是一个具有强烈孝道观念的国家。
地点/参与者：本研究通过提取和链接五个不同数据库的数据，获得了 2012-2015 年间在新加坡死于慢性病的 62951 名（≥21 岁）个体的回顾性队列。在家中死亡定义为在私人住宅中死亡，而非在家中死亡则发生在医院、养老院、临终关怀院和其他场所。85 岁或以上（OR4.45，95%CI3.55-5.59）、女性（OR1.21，95%CI1.16-1.25）和马来族裔（OR1.91，95%CI1.82-2.01）与在家中死亡相关。与恶性肿瘤相比，糖尿病（OR1.93，95%CI1.69-2.20）和脑血管疾病（OR1.28，95%CI1.19-1.36）导致的死亡也与更高的在家中死亡可能性相关。独立地，接受家庭姑息治疗（OR3.45，95%CI3.26-3.66）和有记录的家庭死亡偏好（OR5.08，95%CI3.96-6.51）增加了在家中死亡的可能性，但在生命末期被收治到急性医院则与较低的可能性相关（OR0.92，95%CI0.90-0.94）。
除了文化和临床因素外，基于系统的因素，包括获得家庭姑息治疗以及讨论和记录偏好，也被发现会影响在家中死亡的可能性。如果这是患者的期望选择，增加家庭姑息治疗能力和促进预先护理计划可以促进在家中死亡。
