Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan.
Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan.
Geriatr Gerontol Int. 2022 Dec;22(12):1005-1012. doi: 10.1111/ggi.14496. Epub 2022 Nov 14.
The Japanese government is promoting physician-led home visits as well as end-of-life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years.
To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals.
This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed-up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home.
We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person-years (95% confidence interval 116.1-163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full-time caregiver increased the likelihood of deaths at home relative to deaths at other locations.
Of deceased patients, only one-third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005-1012.
日本政府正在推动医生主导的家访以及在家中进行临终关怀。然而，过去 20 年来，在家中去世的比例一直保持不变。
报告在家中去世的累积发生率，并探讨与在家中去世相关的因素，主要是与在医院去世的比较。
这是一项在初级保健环境中进行的多中心前瞻性队列研究。我们招募了年龄≥65 岁的患者，这些患者从 2013 年 2 月 1 日至 2016 年 1 月 31 日期间开始接受来自东京及其周边地区 13 个医疗机构的家庭医生的定期访视。患者随访至 2017 年 1 月 31 日。主要结局指标是死亡率和在家中死亡的累积发生率。
我们共招募了 762 名患者。在 368 例死亡中，有 133 例发生在患者家中。家中的死亡率为 137.6/1000 人年（95%置信区间 116.1-163.1）。在累积发生率函数中，在家中护理时间越长，在家中死亡的可能性越低。多变量多项逻辑回归模型显示，年龄较小和 Barthel 指数评分较高降低了在家中死亡的可能性，而接受氧气治疗和有全职护理人员则增加了在家中死亡的可能性，而不是在其他地点死亡。
在已故患者中，只有三分之一在家中去世。我们发现了一些与在家中去世相关的因素，这些因素似乎反映了患者及其家属对死亡的准备情况。老年医学与老年病学国际 2022;22:1005-1012。
