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Sakano T, Anzai T, Takahashi K, Fukui S. Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study. J Nurs Scholarsh 2024; 56:191-201. [PMID: 37642168 DOI: 10.1111/jnu.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. DESIGN This was a retrospective cohort study. METHODS We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. RESULTS Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). CONCLUSION Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. CLINICAL RELEVANCE When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.
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Affiliation(s)
- Tomomi Sakano
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sakiko Fukui
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Watanabe T, Matsushima M, Kaneko M, Aoki T, Sugiyama Y, Fujinuma Y. Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan. Geriatr Gerontol Int 2022; 22:1005-1012. [PMID: 36374192 PMCID: PMC10100087 DOI: 10.1111/ggi.14496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND 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. OBJECTIVES To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Takamasa Watanabe
- 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
| | - Masato Matsushima
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Department of Health Data Science Yokohama City University Yokohama Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Makoto Kaneko
- Department of Health Data Science Yokohama City University Yokohama Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development Japanese Health and Welfare Co‐operative Federation Tokyo Japan
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Wammes JD, Nakanishi M, van der Steen JT, MacNeil Vroomen JL. The Revised Medical Care Act is associated with a decrease in hospital death for the total Japanese older adult population regardless of dementia status: An interrupted time series analysis. PLoS One 2022; 17:e0264624. [PMID: 35239744 PMCID: PMC8893620 DOI: 10.1371/journal.pone.0264624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background 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. Methods and findings 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. Conclusion 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.
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Affiliation(s)
- Joost D. Wammes
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janet L. MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Coe NB, Konetzka RT, Berkowitz M, Blecker E, Van Houtven CH. The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020. Annu Rev Public Health 2021; 42:483-503. [PMID: 33395544 DOI: 10.1146/annurev-publhealth-090419-102354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.
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Affiliation(s)
- Norma B Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - R Tamara Konetzka
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois 60637-1447, USA;
| | - Melissa Berkowitz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Emily Blecker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina 27708, USA; .,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina 27705, USA
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Sugiyama K, Tsuboya T, Okita T, Tsuchiya N, Tarasawa K, Ogata T, Yanaka S, Tomoda A. Residents in a Remote Island Having Family Members in Distant Areas Showed Higher Preference for Place of End-of-Life Care: The Ajishima Study. JMA J 2020; 3:138-145. [PMID: 33150246 PMCID: PMC7590377 DOI: 10.31662/jmaj.2019-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 03/17/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION To investigate the proportion of those having preferred place for end-of-life care among residents in a remote island and its association with family composition. METHODS Cross-sectional questionnaire survey was conducted in Ajishima, an island 23 km away from the coast of Ishinomaki City, northeast of Japan. Between October 2017 and February 2018, the questionnaire was distributed to 288 eligible residents and 113 valid responses were analyzed. Primary outcome was whether the subjects had preferred place for end-of-life care. The explanatory variable was family composition defined as whether having family members inside or outside the island [none (In-/Out-), only inside the island (In+/Out-), only outside the island (In-/Out+), and both inside and outside (In+/Out+)]. Poisson regression analysis was used to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of showing preferred place in each group. RESULTS The proportion of those having preferred place for end-of-life care was 72.6% in total. This rate significantly differed across family composition groups: 67.6%, 40.0%, and 82.9% for In+/Out+, In+/Out-, and In-/Out+ groups, respectively. The PR (95%CI) of having preferred place was 0.66 (0.33, 1.36) and 1.26 (1.01, 1.56) for In+/Out- and In-/Out+ groups, respectively, compared with In+/Out+ group. CONCLUSIONS This study showed that significantly higher preference for place of end-of-life care was seen among residents who had family members only outside the island compared with those who had families both inside and outside. Health care professionals should consider family compositions when initiating end-of-life discussion to residents in remote areas.
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Affiliation(s)
- Kemmyo Sugiyama
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Internal Medicine, Amishou Clinic, Ishinomaki, Japan
| | - Toru Tsuboya
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Taketoshi Okita
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naho Tsuchiya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoaki Ogata
- Division of Health Administration and Policy, Tohoku Medical and pharmaceutical University, Faculty of Medicine, Sendai, Japan
| | - Shintaro Yanaka
- Department of Internal Medicine, Amishou Clinic, Ishinomaki, Japan
| | - Akio Tomoda
- Department of Internal Medicine, Amishou Clinic, Ishinomaki, Japan
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Masumoto S, Sato M, Ichinohe Y, Maeno T. Factors facilitating home death in non-cancer older patients receiving home medical care. Geriatr Gerontol Int 2019; 19:1231-1235. [PMID: 31691507 DOI: 10.1111/ggi.13800] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/08/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
AIM To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners. METHODS A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death. RESULTS Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths. CONCLUSIONS Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death. Geriatr Gerontol Int 2019; 19: 1231-1235.
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Affiliation(s)
- Shoichi Masumoto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Kawakita Center for Family Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Mikiya Sato
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yumiko Ichinohe
- Kawakita Center for Family Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Morioka N, Tomio J, Seto T, Yumoto Y, Ogata Y, Kobayashi Y. Association between local-level resources for home care and home deaths: A nationwide spatial analysis in Japan. PLoS One 2018; 13:e0201649. [PMID: 30142197 PMCID: PMC6108466 DOI: 10.1371/journal.pone.0201649] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Abstract
Aim Little is known about whether and how local-level resources regarding home care are associated with the prevalence of home deaths. We aimed to investigate whether geographic patterns of the resources for home care were associated with the prevalence of home deaths, taking spatial variation into consideration. Methods We conducted an ecological cross-sectional study in Japan using nationwide data in 2014. The areal unit was the municipality, the smallest administrative unit in Japan. We investigated the association between the percentage of home deaths and the resources of home care support clinics with available 24-hour-a-day functions, considering the geographic effect of neighboring municipalities by applying a geographically weighted regression model. Results The mean and standard deviation of the percentages of home deaths were 11.4% (5.0%), and those of the number of home care support clinics per 10,000 elderly population were 3.4 (3.7). The percentages of home deaths in neighboring municipalities tended to be significantly correlated (Moran’s I 0.34, p<0.001). Adjusting for the number of hospital beds, total population, and the socio-economic status of municipality, the results of an ordinary least squares regression model showed a positive correlation between the percentage of home deaths and the local resources for home care support clinics per 10,000 elderly population (regression coefficient 0.15, 95% confidence interval 0.07, 0.22), while the existence of spatial autocorrelation of the residual was suggested (Moran’s I of the residual 0.227, p<0.001). The geographically weighted regression model showed local regression coefficients varying across municipalities with a better model fit over the analogous ordinary least squares model (adjusted R2 0.414 vs. 0.131). Conclusion Home deaths were more prevalent in municipalities with greater home care resources. This association was geographically varied and further strengthened in some areas.
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Affiliation(s)
- Noriko Morioka
- Department of Gerontological Nursing & Care System Development, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshikazu Seto
- Center for Spatial Information Science, The University of Tokyo, Tokyo, Japan
| | - Yoshie Yumoto
- Department of Gerontological Nursing & Care System Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuko Ogata
- Department of Gerontological Nursing & Care System Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Naruishi K, Nishikawa Y. Swallowing impairment is a significant factor for predicting life prognosis of elderly at the end of life. Aging Clin Exp Res 2018; 30:77-80. [PMID: 28391586 DOI: 10.1007/s40520-017-0756-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In end-of-life care of elderly, the decision of care plan including gastrostomy is difficult frequently because of insufficient knowledge relating the life prognosis of elderly. It is important the families to decide correctly the life prognosis of elderly with geriatric diseases. Our purpose is to examine the significant factors for predicting life prognosis of elderly in end-of-life care. METHODS A total of 320 elderly patients was enrolled (male/female 151/169; averaged age: male 84.7 ± 5.9 year, female 86.8 ± 6.3 year) and retrospective analyses were performed. The elderly patients were classified as either: (1) with or without past illness of aspiration pneumonia; (2) with or without incidence of cerebrovascular disorder; (3) impaired or normal cognitive function; (4) impaired or normal swallowing function, and performed Kaplan-Meier survival analysis. Swallowing function was examined using video endoscopic (VE) evaluation method. The Kaplan-Meier analysis of the number of days from implementation of VE test (day 0) to death was evaluated with the log-rank Mantel-Cox test. The maximum follow-up time recorded was 180 days. RESULTS There were no significant differences in number of days when divided with or without past illness of aspiration pneumonia, cerebrovascular disorder and impaired cognitive function. The survival probabilities of elderly with impaired swallowing function were significant lower than in elderly with the normal function. CONCLUSIONS For judgement of life prognosis, the condition of being frail such as impaired swallowing function might be a useful factor, and the viewpoint would contribute to decide the treatment plan for the good end-of-life care of elderly.
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Affiliation(s)
- Koji Naruishi
- Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8504, Japan.
| | - Yasufumi Nishikawa
- Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8504, Japan
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Medeiros KKAS, Pinto Júnior EP, Bousquat A, Medina MG. O desafio da integralidade no cuidado ao idoso, no âmbito da Atenção Primária à Saúde. SAÚDE EM DEBATE 2017. [DOI: 10.1590/0103-11042017s322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este ensaio objetiva discutir os desafios da integralidade no cuidado ao idoso, no âmbito da Atenção Primária à Saúde, considerando o paradigma da funcionalidade, a atenção domiciliar e a formação profissional, como uma tentativa de fomentar esse debate no âmbito da saúde coletiva.
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Costa V, Earle CC, Esplen MJ, Fowler R, Goldman R, Grossman D, Levin L, Manuel DG, Sharkey S, Tanuseputro P, You JJ. The determinants of home and nursing home death: a systematic review and meta-analysis. BMC Palliat Care 2016; 15:8. [PMID: 26791258 PMCID: PMC4721064 DOI: 10.1186/s12904-016-0077-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 01/06/2016] [Indexed: 11/15/2022] Open
Abstract
Background Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. Methods A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95 % confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Results Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver’s coping skills. Conclusions Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0077-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vania Costa
- Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, M5S 1 N5, ON, Canada.
| | - Craig C Earle
- Ontario Institute for Cancer Research, 101 College Street, Toronto, M5G 1 L7, ON, Canada
| | - Mary Jane Esplen
- de Souza Institute, University Health Network, 700 Bay Street, 19th floor, Toronto, M5G 1Z6, ON, Canada
| | - Robert Fowler
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada
| | - Russell Goldman
- Mount Sinai Hospital, Tammy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, L4-000, Toronto, M5T 3 L9, ON, Canada
| | - Daphna Grossman
- North York General Hospital, 4001 Leslie Street, Toronto, M2K 1E1, ON, Canada
| | - Leslie Levin
- MaRS Discovery District, 101 College Street, Toronto, M5G 1 L7, ON, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada
| | - Shirlee Sharkey
- Saint Elizabeth Health Care , 90 Allstate Parkway, Suite 300, Markham, L3R 6H3, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada
| | - John J You
- Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada
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Guerriere D, Husain A, Marshall D, Zagorski B, Seow H, Brazil K, Kennedy J, McLernon R, Burns S, Coyte PC. Predictors of Place of Death for Those in Receipt of Home-Based Palliative Care Services in Ontario, Canada. J Palliat Care 2015. [PMID: 26201209 DOI: 10.1177/082585971503100203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n = 302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.
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12
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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Is it time for a comprehensive approach in older home care clients’ care planning in Finland? Scand J Caring Sci 2014; 29:317-24. [DOI: 10.1111/scs.12165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- Faculty of Health Sciences; Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Mari Kangasniemi
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland and Health Care Services; Kuopio Finland
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13
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Kashiwagi M, Tamiya N, Murata M. Characteristics of visiting nurse agencies with high home death rates: A prefecture-wide study in Japan. Geriatr Gerontol Int 2014; 15:936-43. [PMID: 26095959 DOI: 10.1111/ggi.12372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Abstract
AIM The purpose of the present study was to identify characteristics of visiting nurse agencies (VNA) in Japan with high home death rates by a prefecture-wide survey. METHODS A cross-sectional study of visiting nurse agencies (n = 101) in Ibaraki Prefecture, Japan, was completed. Data included the basic characteristics of each VNA, the type of services provided, level of coordination with other service providers, total number of VNA patients who died per year and place of death and contractual relationship with home-care supporting clinics providing end-of-life care services in the home 24 h a day. The VNA characteristics were analyzed by logistic regression, using the home death rate per VNA as a dependent variable. RESULTS A total 69 agencies, excluding those that did not report number of deaths (n = 14) and those without deaths during the year (n = 6), were analyzed. The median home death rate of the 69 VNA was 29.8%. The results of logistic regression analysis showed that higher home death rate was significantly associated with lack of attachment to a hospital, existence of a contractual relationship with home-care supporting clinics and existence of an interactive information exchange through telephone/face-to-face communication with attending physicians. CONCLUSIONS In order to increase the home death rate of people using VNA, policymakers must consider establishing home-based service systems within the community that can provide home end-of-life care services 24 h a day, and support the interactive exchange of information between the visiting nurse and the attending physician.
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Affiliation(s)
- Masayo Kashiwagi
- Department of Nursing Management, School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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14
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Akar T, Karapirli M, Akcan R, Demirel B, Akduman B, Dursun AZ, Sari S, Özkök A. Elderly deaths in Ankara, Turkey. Arch Gerontol Geriatr 2014; 59:398-402. [PMID: 24962235 DOI: 10.1016/j.archger.2014.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
According to World Health Organization, the life expectancy at birth is increasing. An increase in life expectancy might result in increased morbidity and mortality in elderly. The increase in the elderly population also leads to an increase in medico-legal problems, as well. Autopsy is of high importance for determination of cause of death in clinical and forensic cases. The purpose of this study was to find out general characteristics elderly deaths by examining forensic autopsy records. Out of 7033 forensic autopsies performed between years of 2007 and 2011, 1324 were elderly deaths and were included in the scope of the study. The records of public prosecutor office, crime scene investigation and autopsy findings were examined. The majority of victims (70.6%) were male, while 29.4% were female, with a male to female ratio of 2.4/1. Victims' ages ranged between 65 and 96 years, and the mean age was 74.8 years. A great number of presented elderly deaths were due to unnatural causes, followed by natural deaths cases. Out of unnatural deaths, 63.2% were related to accidents, 23.7% were suicides, and remaining 13.1% were homicides. More than half (56.6%) of all suicidal deaths were due to hanging. Of natural deaths, the majority (82.7%) were due to cardiovascular system disease. In the presented series the cause of death was determined in 90.9% of all elderly deaths, which validates the need for a forensic autopsy. Data obtained through autopsy procedures is of high importance for death statistics.
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Affiliation(s)
- Taner Akar
- Gazi University School of Medicine, Department of Forensic Medicine, Besevler, Ankara, Turkey.
| | - Mustafa Karapirli
- Council of Forensic Medicine Ankara Group Administration, Kecioren, Ankara, Turkey
| | - Ramazan Akcan
- Hacettepe University School of Medicine, Department of Forensic Medicine, Sıhhiye, Ankara, Turkey
| | - Birol Demirel
- Gazi University School of Medicine, Department of Forensic Medicine, Besevler, Ankara, Turkey
| | - Barış Akduman
- Council of Forensic Medicine Ankara Group Administration, Kecioren, Ankara, Turkey
| | - Ahmet Zahit Dursun
- Gazi University School of Medicine, Department of Forensic Medicine, Besevler, Ankara, Turkey
| | - Serhat Sari
- Gazi University School of Medicine, Department of Forensic Medicine, Besevler, Ankara, Turkey
| | - Alper Özkök
- Gazi University School of Medicine, Department of Forensic Medicine, Besevler, Ankara, Turkey
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15
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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Living longer at home: a qualitative study of older clients' and practical nurses' perceptions of home care. J Clin Nurs 2014; 23:3206-17. [PMID: 25453125 DOI: 10.1111/jocn.12569] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. BACKGROUND The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DESIGN A descriptive qualitative study METHODS Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. RESULTS Both participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. CONCLUSION In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. RELEVANCE TO CLINICAL PRACTICE The information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.
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16
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Turjamaa R, Hartikainen S, Pietilä AM. Forgotten resources of older home care clients: Focus group study in Finland. Nurs Health Sci 2013; 15:333-9. [DOI: 10.1111/nhs.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/19/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; University of Eastern Finland; Kuopio; Finland
| | - Sirpa Hartikainen
- Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio; Finland
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17
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Kawagoe S, Tsuda T, Doi H. Study on the factors determining home death of patients during home care: a historical cohort study at a home care support clinic. Geriatr Gerontol Int 2012; 13:874-80. [PMID: 23279052 DOI: 10.1111/ggi.12018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Abstract
AIM Associations between markedly low activities of daily living (ADL) at the start of home visit care and patient home death were analyzed using data from a home care support clinic in Japan that has a low rate of home deaths. METHODS The study was a historical cohort study. It involved patients who began to receive home visit care from a home visit care support clinic between 1 April 2006 and 31 March 2011. Using home death as a dependent variable and presence/absence of markedly low ADL and other parameters (cancer, the patient's desire for home death, etc.) as independent variables, the adjusted hazard ratio and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. RESULTS Markedly low ADL were associated with home death even after adjustment for factors that influence home death (adjusted hazard ratio 4.40; 95% CI 2.37-8.16). Cancer and the patient's desire for home death were statistically significant factors involved in home death. In a subgroup analysis according to the presence/absence of cancer, the association between markedly low ADL and home death was stronger in the cancer-free group (adjusted hazard ratio 10.78; 95% CI 2.89-40.26) than in the cancer group (adjusted hazard ratio 5.58; 95% CI2.39-13.05). CONCLUSION Patients' desire for home death could be fulfilled if home care support clinics provide home visit services to not only terminal-stage cancer patients, but also bedridden cancer-free patients. We must establish systems for older adults to remain at home during the terminal period of their lives.
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Affiliation(s)
- Seiji Kawagoe
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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