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.
PLoS One. 2022 Mar 3;17(3):e0264624. doi: 10.1371/journal.pone.0264624. eCollection 2022.
In 2006, Japan introduced the Revised Medical Care Act aimed to shift end-of-life care from hospitals to communities. For patients and families, dying in hospital can be highly distressing. Persons with dementia are especially susceptible to negative hospital-related outcomes. This study aims to evaluate whether the Revised Medical Care Act is associated with a decrease in the proportion of hospital deaths for older adults and persons with dementia over a 20-year period covering the reform.
This is a population-level, repeated cross-sectional study using mortality data from Vital Statistics Japan. Participants were Japanese older adults 65 years or older with and without dementia who died between 1996 and 2016. The policy intervention was the 2006 Revised Medical Care Act that increased community care infrastructure. The primary outcome was location of death in hospital, nursing home, home, or elsewhere. The trend in the proportion of location of death, before and after the reforms was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 19,307,104 older adult decedents, 216,442 had dementia identified on their death certificate. Death in nursing home (1.10, 95% CI 1.10-1.10), home (1.08, 95% CI 1.08-1.08), and elsewhere (1.07, 95% CI 1.07-1.07) increased over time compared to hospital deaths for the total population after reform implementation. Nursing home (1.04, 95% CI 1.03-1.05) and home death (1.11, 95% CI 1.10-1.12) increased after reform implementation for persons with dementia.
This study provides evidence that the 2006 Revised Medical Care Act was associated with decreased older adults dying in hospital regardless of dementia status; however, hospital continues as the primary location of death.
2006 年，日本出台了《修订医疗保健法》，旨在将临终关怀从医院转移到社区。对于患者及其家属来说，在医院去世可能会带来高度的痛苦。痴呆症患者尤其容易受到与医院相关的负面结果的影响。本研究旨在评估《修订医疗保健法》是否与改革后 20 年间老年患者和痴呆症患者在医院死亡的比例下降有关。
这是一项基于人群的重复横断面研究，使用日本人口动态统计数据中的死亡率数据。参与者为 1996 年至 2016 年期间在医院去世的年龄在 65 岁及以上且患有或不患有痴呆症的日本老年人。政策干预措施是 2006 年出台的《修订医疗保健法》，该法增加了社区护理基础设施。主要结局是在医院、养老院、家中或其他地方死亡的地点。使用中断时间序列分析估计改革前后死亡地点比例的趋势。所有分析均根据性别和季节性进行调整。在 19307104 名老年死者中，有 216442 人在死亡证明上被诊断患有痴呆症。与改革前相比，改革后养老院（1.10，95%CI 1.10-1.10）、家中（1.08，95%CI 1.08-1.08）和其他地方（1.07，95%CI 1.07-1.07）的死亡人数增加。对于改革后实施的所有人群，与医院死亡相比，养老院（1.04，95%CI 1.03-1.05）和家中死亡（1.11，95%CI 1.10-1.12）增加。
本研究提供了证据表明，2006 年《修订医疗保健法》的实施与无论痴呆症状况如何，老年患者在医院死亡的比例下降有关；然而，医院仍然是死亡的主要场所。
