[Factors influencing the death of the elderly at home in an institution specializing home medical care--analysis of survey of the bereaved family]

Association between local-level resources for home care and home deaths: A nationwide spatial analysis in Japan

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.

Occupational Experiences of and Psychological Adjustment by Family Members of Cancer Patients

Objective/Background

This qualitative analysis aimed to provide valuable insight into the occupational experiences of and psychological adjustments by family members who act as palliative caregivers. In addition, we also aimed to investigate and clarify these complex experiences and formulate results that are both meaningful and important to the families themselves.

Methods

Families who had lost a family member (n = 9) and were part of a palliative treatment support programme were identified through introductions from healthcare workers. They were individually interviewed using both casual questioning and semistructured questionnaires. The data were analysed using the grounded theory approach.

Results

The following six core categories were identified using grounded theory analysis: (a) being overwhelmed by pressure, (b) occupation while living with the illness, (c) living without being overwhelmed by anxiety, (d) having difficulties in regulating emotions, (e) comforting memories of the occupational experiences, and (f) leading to a change in emotions.

Conclusion

Occupational experiences can play a significant role in the psychological adjustment of families of terminally ill cancer patients.

Importance of end-of-life support to minimize caregiver's regret during bereavement of the elderly for better subsequent adaptation to bereavement

This study examined whether the quality of end-of-life home medical care affected caregiver's psychological recovery from bereavement. We analyzed survey responses from an anonymous self-administered questionnaire from 147 bereaved family members (caregivers). Questionnaire content included information on the quality of end-of-life home medical care, feelings during bereavement and present feelings. Results showed that caregiver regret during bereavement was significantly associated with present feelings about loss regardless of the length of time after death of a loved one. Aspects of end-of-life support that were statistically significant at minimizing regret during bereavement were: (1) fulfilled home medical care service system, (2) peaceful death of the patient, and (3) providing direct care by the caregiver. These findings suggest that end-of-life support to minimize caregiver regret during bereavement was crucial for better subsequent adaptation to bereavement.

Factors enabling home death of the elderly in an institution specializing in home medical care: analysis of apprehension of the bereaved family

AIM

To determine the factors enabling home death despite caregiver apprehension about home medical care.

METHODS

This study was an anonymous mailed survey of bereaved family members (the caregiver) of patients who died in a home medical care setting provided by an institution specializing in home medical care in Japan (home death rate, approximately 80%). We analyzed the relationships between caregiver apprehension about home medical care, overall satisfaction with home medical care and the place of death.

RESULTS

Higher caregiver apprehension about home medical care and lower overall satisfaction with home medical care were significantly associated with dying in a hospital. In addition, the home death group with apprehension about home medical care significantly rated higher overall satisfaction with home medical care than the hospital death group. Meanwhile, there was no difference in the overall satisfaction with home medical care between those with or without apprehension about home medical care in the home death group. Factors influencing overall satisfaction with home medical care in the home death group with apprehension about home medical care were: (i) being free from pain or symptoms (partial regression coefficient: 0.83); and (ii) fulfilled medical care service system (partial regression coefficient: 0.40).

CONCLUSION

These results suggest that caregiver satisfaction with home medical care is an essential factor to enable home death of the patient despite the caregiver apprehension about home medical care.

[Preferred and actual place of death among community-dwelling disabled older people: findings from a survey of visiting nurses]

AIM

The purpose of this study was to examine the relationship between preferred and actual place of death in community-dwelling disabled older people, based on a survey of visiting nurses.

METHODS

The present study was a two-year longitudinal study. At Time 1, 398 disabled older people were living together with their family caregivers. At Time 2 (two years later), the visiting nurses responded to a survey for these 398 disabled older people. The relationship between preferred and actual place of death of disabled older people was examined.

RESULTS

Of these disabled older people, 26.4% had died by Time 2. The preferences of the place of death of 60% of the disabled older people were not identified by the visiting nurses. Approximately 40% of the family caregivers' preferences concerning the place of death for their older adults were not identified by the visiting nurses. The disabled older adults tended to die at their preferred place of death if the visiting nurses had identified the preferences.

CONCLUSION

In order to assist disabled older people to die at their preferred place of death, visiting nurses should identify the preferences of disabled older people or their family concerning the place of death of the disabled older people.