Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan.
J Alzheimers Dis. 2021;83(2):791-797. doi: 10.3233/JAD-210521.
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.
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.
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.
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.
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.
日本是世界上痴呆症患者和医院死亡人数比例最高的国家之一。医院通常不具备处理终末期痴呆症患者所需的护理复杂性的能力。国家痴呆症橙色计划旨在通过扩大社区时间来减少医院死亡人数。
本研究旨在评估国家痴呆症橙色计划是否与痴呆症患者的医院死亡人数减少有关。
我们使用了季度、横断面、全国死亡证明数据，其中包括 2009 年至 2016 年期间年龄在 65 岁及以上的日本全部痴呆症人口。主要结果是医院、疗养院、家庭或其他地方死亡的季度调整相对风险率（aRRR）。进行了中断时间序列分析以研究随时间的斜率变化。分析调整了性别和季节性。
共有 149638 人死于痴呆症。随着橙色计划的实施，疗养院（aRRR 1.08，[1.07-1.08]，p<0.001）和其他地方（aRRR 1.05，[1.05-1.06]，p<0.001）的死亡人数随着时间的推移呈上升趋势，而医院死亡人数则没有变化。
本研究提供了证据表明，国家痴呆症橙色计划与疗养院和其他地方的死亡人数略有增加有关。医院死亡仍然是主要的死亡地点。临终策略应在国家痴呆症政策中扩大，以增加社区中的老龄化直至死亡。
