Department of Nursing Science, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University.
Co-learning Community Healthcare Re-innovation Office, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University.
J Epidemiol. 2024 Oct 5;34(10):493-497. doi: 10.2188/jea.JE20230279. Epub 2024 May 31.
A key measure of the effectiveness of end-of-life care is the place of death. The coronavirus disease 2019 (COVID-19) pandemic affected end-of-life care and the circumstances of patients with dementia.
This observational, retrospective cohort study used Japanese national data to examine the numbers and locations of reported deaths among patients with dementia older than 65 years during the COVID-19 pandemic. Locations were grouped as medical institutions, nursing facilities, homes, or all settings. The quasi-Poisson regression model known as the Farrington algorithm was employed.
Between December 30, 2019, and January 29, 2023, 279,703 patients who died of causes related to dementia were reported in Japan. A decline was seen in early 2020, followed by increased numbers of deaths in homes, medical facilities, and nursing homes beginning in October 2020, December 2020, and March 2021, respectively. In 2021, the percentage of excess deaths at home peaked at 35.2%, while in 2022, those in medical facilities and nursing homes peaked at 18.8% and 16.6%, respectively. In 2022, the percentage of excess deaths in nursing homes exceeded that of other locations.
The results suggest a change in the preferred place of death, along with pandemic-related visitation restrictions among healthcare facilities. Excess deaths also suggest strained medical resources and limited access to care. Methodological limitations include data from a limited period (2017 onwards) and post-2020 data used to estimate data after 2021, albeit with weighting. Considering these findings, physicians should reconfirm preferred places of death among older patients with dementia.
临终关怀效果的一个关键衡量标准是死亡地点。2019 年冠状病毒病（COVID-19）大流行影响了临终关怀以及痴呆症患者的情况。
这项观察性、回顾性队列研究使用日本国家数据，调查了 COVID-19 大流行期间 65 岁以上痴呆症患者报告的死亡人数和地点。地点分为医疗机构、护理机构、家庭或所有场所。采用称为法灵顿算法的准泊松回归模型。
2019 年 12 月 30 日至 2023 年 1 月 29 日，日本报告了 279703 例与痴呆相关的死因患者死亡。2020 年初有所下降，随后 2020 年 10 月、2020 年 12 月和 2021 年 3 月，家中、医疗设施和养老院的死亡人数分别增加。2021 年，家中超额死亡人数的百分比达到峰值，为 35.2%，而 2022 年，医疗设施和养老院的超额死亡人数分别达到峰值，为 18.8%和 16.6%。2022 年，养老院超额死亡人数超过其他地点。
研究结果表明，随着与大流行相关的医疗保健设施探视限制，死亡地点发生了变化。超额死亡人数还表明医疗资源紧张和获得护理的机会有限。方法学上的局限性包括数据来自有限的时间段（2017 年及以后），以及 2020 年后的数据用于估计 2021 年后的数据，尽管进行了加权。考虑到这些发现，医生应该重新确认老年痴呆症患者的首选死亡地点。
