Shirakata Takumi, Tabuchi Sayaka, Ito Mikiko, Miura Katsuyuki, Sobue Tomotaka
Department of Public Health Nursing, Shiga University of Medical Science.
Department of Public Health, Shiga University of Medical Science.
Nihon Koshu Eisei Zasshi. 2025 Mar 26;72(3):227-237. doi: 10.11236/jph.24-038. Epub 2024 Dec 23.
Objectives In Japan, efforts to provide "end-of-life care" in nursing homes are increasing and its introduction through long-term care insurance in 2006 is a major step forward. However, previous studies have shown that relocating older adults to their end-of-life care affects their burden. This study examined individuals' end-of-life care use under long-term care insurance in older care facilities and investigated the relocation frequency among terminally ill older residents of nursing facilities using receipt data.Methods The research targeted individuals aged ≥ 65 years under long-term care insurance who used formal end-of-life care services and were passed into residential facilities between April 1, 2018 and March 31, 2021. Data were obtained from anonymous long-term care certification information provided by the Ministry of Health, Labor, and Welfare. Six facilities providing end-of-life care were considered; older care facilities, geriatric health service facilities, designated establishments, and dementia group homes. A total of 233,735 individuals with service use records in the month of service cessation were aggregated according to facility, individual factors, and prefecture. Additionally, we defined end-of-life relocation as occurring if three categories of end-of-life care fees (day of death, 1-2 days before death, and 4-30 days before death) did not continue until the day of death.Results The participants were individuals aged ≥ 85 years (83.35%), 25.29% were men, and 93.53% required a care level of ≥ 3. Older nursing care facilities recorded the highest number (114,356) of end-of-life care users. The proportion of individuals with moderate-to-severe dementia (level ≥ IIIa; approximately 80%) was higher in nursing homes for older adults, community-based nursing homes for older adults, and dementia group homes than in other facilities. Relocation during the terminal phase was less prevalent in facilities with higher doctor and nurse staffing levels. At the individual level, relocation is more frequent among men, younger individuals, those with lower care levels, and those with intact decision-making and communication abilities. Conclusion Terminally ill residents aged ≥ 80 years with severe levels of care were the most likely to use end-of-life care. Moreover, 0.2-2% relocated across all facilities within 30 days before death. The relocation frequency increased based on individual factors and was mitigated by a thorough system of medical staff deployment.
目标 在日本，养老院提供“临终关怀”的努力不断增加，2006年通过长期护理保险引入临终关怀是向前迈出的重要一步。然而，先前的研究表明，将老年人转移至临终关怀机构会影响他们的负担。本研究调查了老年护理机构中使用长期护理保险的个人临终关怀情况，并利用接收数据调查了护理机构中晚期患病老年居民的转移频率。
方法 本研究的对象是年龄≥65岁、使用正规临终关怀服务并于2018年4月1日至2021年3月31日期间入住养老机构的长期护理保险参保者。数据来自厚生劳动省提供的匿名长期护理认证信息。研究考虑了六类提供临终关怀的机构；老年护理机构、老年保健服务机构、指定机构和痴呆症集体之家。根据机构、个人因素和所在县，汇总了在服务终止当月有服务使用记录的233,735名个人。此外，我们将临终转移定义为如果三类临终关怀费用（死亡当天、死亡前1 - 2天和死亡前4 - 30天）在死亡当天之前没有持续发生。
结果 参与者年龄≥85岁（83.35%），男性占25.29%，93.53%的人护理等级≥3级。老年护理机构记录的临终关怀使用者数量最多（114,356人）。中重度痴呆（等级≥IIIa；约80%）患者在老年养老院、社区老年护理院和痴呆症集体之家中的比例高于其他机构。在医生和护士配备水平较高的机构中，临终阶段的转移情况较少见。在个人层面，男性、较年轻的人、护理等级较低的人以及决策和沟通能力完好的人转移更为频繁。
结论 年龄≥80岁、护理等级较高的晚期患病居民最有可能使用临终关怀。此外，0.2% - 2%的人在死亡前30天内在所有机构间发生了转移。转移频率因个人因素而增加，而完善的医护人员配置系统可减轻这种情况。
