Kosaka Makoto, Miyatake Hirotomo, Hara Akemi, Arita Satoshi, Tsunetoshi Chie, Masunaga Hidehisa, Kotera Yasuhiro, Sakamoto Ryo, Nishikawa Yoshitaka, Ozaki Akihiko, Beniya Hiroyuki
Orange Home-Care Clinic, Fukui City, Fukui, Japan.
Medical Governance Research Institute, Minato City, Tokyo, Japan.
Medicine (Baltimore). 2025 May 16;104(20):e42501. doi: 10.1097/MD.0000000000042501.
To clarify the patterns, reasons, and patient characteristics associated with emergency visits in the final 30 days of life for patients receiving home care in Japan. We conducted a retrospective analysis of emergency visits made by home care physicians to patients who died while receiving home care in 2018. Data on patient characteristics and emergency visits during the final 30 days of life were extracted from medical records. Poisson regression analysis was used to identify factors associated with emergency visit frequency. Among 83 end-of-life patients (median age 84 years, 49.4% male), a total of 86 emergency visits were recorded. These visits occurred most frequently in the days immediately preceding death, with 40.7% occurring within 5 days before death. Visits were more common during afternoons (37.2%) and weekends (39.6%). The primary reasons for visits included respiratory distress (20.9%), clinical assessment (14.0%), and neurological symptoms (12.8%). While some visits resulted in medication prescriptions (26.7%) or laboratory tests (22.1%), 36.1% involved observation only. Multivariable analysis revealed that longer duration of home care was associated with increased emergency visit frequency (31-365 days: relative risk [RR] 2.30, 95% confidence interval [CI]: 1.16-4.54; >365 days: RR 3.00, 95% CI: 1.56-5.78), while younger age was associated with increased visits (≤79 years: RR 2.04, 95% CI: 1.19-3.47). Emergency home visits in the terminal phase often clustered near death and frequently resulted in observation only, suggesting that some visits may be driven more by caregiver anxiety than medical urgency. Additionally, care level appeared to play a limited role during this period. These findings highlight the need for proactive symptom management, caregiver support, and scalable approaches such as telehealth to optimize end-of-life care.
为了阐明日本接受居家护理患者在生命最后30天内急诊就诊的模式、原因及患者特征。我们对2018年居家护理医生对接受居家护理期间死亡患者的急诊就诊情况进行了回顾性分析。从病历中提取了患者特征及生命最后30天内急诊就诊的数据。采用泊松回归分析来确定与急诊就诊频率相关的因素。在83例临终患者（中位年龄84岁，男性占49.4%）中，共记录到86次急诊就诊。这些就诊最常发生在死亡前几天，40.7%发生在死亡前5天内。就诊在下午（37.2%）和周末（39.6%）更为常见。就诊的主要原因包括呼吸窘迫（20.9%）、临床评估（14.0%）和神经症状（12.8%）。虽然部分就诊导致了药物处方（26.7%）或实验室检查（22.1%），但36.1%仅涉及观察。多变量分析显示，居家护理时间较长与急诊就诊频率增加相关（31 - 365天：相对风险[RR] 2.30，95%置信区间[CI]：1.16 - 4.54；>365天：RR 3.00，95% CI：1.56 - 5.78），而年龄较小与就诊增加相关（≤79岁：RR 2.04，95% CI：1.19 - 3.47）。终末期的急诊居家就诊常在死亡临近时集中出现，且常仅导致观察，这表明部分就诊可能更多是由照护者焦虑而非医疗紧迫性所驱动。此外，在此期间护理水平似乎作用有限。这些发现凸显了积极进行症状管理、照护者支持以及采用远程医疗等可扩展方法以优化临终护理的必要性。
