End-of-life care for older adults receiving home medical care in Japan: a pilot retrospective cohort study.

Objective

Home medical care plays an important role in supporting aging and dying in one's preferred place. However, little is known regarding end-of-life (EOL) care among older adults receiving home medical care. This study aimed to describe the EOL characteristics in this population and identify factors associated with dying at home. Patient/Materials and

Methods

In this retrospective cohort study, we used clinical data derived from a single home medical clinic in Tokyo, Japan. The study participants were adults aged ≥65 years who had received home medical care and died between April 2016 and October 2022. Demographic characteristics, clinical conditions, long-term care needs, family caregiving arrangements, advance care planning (ACP), hospitalizations, emergency department visits, and place of death were extracted from medical records. Logistic regression analysis was performed to examine factors associated with home death.

Results

Of the 85 patients included in this study (mean age, 91.8 ± 7.3 years; 69.4% female), almost half had received home medical care for ≥5 years, and most required a high level of long-term care. Dementia was identified as the most common underlying condition. ACP was conducted for 75.3% of participants, whereas only 31.8% had living will documents. Home was the most frequent place of death (42.4%), followed by hospitals (32.9%) and residential facilities (24.7%). Multivariable logistic regression analysis revealed a significant association between conducting ACP and a higher likelihood of dying at home (odds ratio, 5.48; 95% confidence interval, 1.29-23.3). In contrast, no significant associations were detected between a home death and possession of a living will document, hospitalization, or emergency department visits.

Conclusion

The findings of this study highlight the importance of ACP discussions involving patients, families, and healthcare professionals in supporting end-of-life care, which is consistent with the preferences of older adults.