General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
General Medicine, Toyota Regional Medical Center, Toyota, Japan.
Geriatr Gerontol Int. 2021 Jun;21(6):525-531. doi: 10.1111/ggi.14173. Epub 2021 Apr 27.
To evaluate unique factors associated with home death in older Asian individuals who received physician-led home healthcare.
We carried out a case-control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician-led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death.
A total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52-27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15-25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13-26.19).
Older age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525-531.
评估在接受医师主导的家庭医疗保健的老年亚洲个体中，与在家中死亡相关的独特因素。
我们在日本的一家医院进行了一项病例对照研究，时间为 2018 年 2 月至 2019 年 12 月。我们纳入了开始接受医师主导的家庭医疗保健并在家中死亡的患者作为病例，以及接受相同类型的护理但在医院死亡的患者作为对照。使用多变量逻辑回归评估与在家中死亡相关的因素。
共纳入 152 名患者（平均年龄 70.3±11.2 岁；86[56.6%]名男性），其中 89 名（58.6%）在家中死亡，63 名（41.4%）在医院死亡。比较两组患者，在医院死亡组中，与护理相关的家庭心理问题更为常见（家中死亡 49.4%；医院死亡 32.3%，P=0.036）。与年龄<75 岁的患者相比，年龄>85 岁的患者（调整后优势比 6.47，95%置信区间 1.52-27.48）和症状数量最高四分位数的患者（调整后优势比 5.45，95%置信区间 1.15-25.95）更倾向于在家中死亡。家庭成员希望患者在家中死亡与在家中死亡相关（调整后优势比 7.47，95%置信区间 2.13-26.19）。
年龄较大和多种症状与在家中死亡相关。患者的意愿与死亡地点无关，但与家庭成员的意愿有关。这些结果可能反映了亚洲特有的家庭观念。
