Hospital death in dementia patients and regional provision of palliative and end-of-life care: National patient data analysis

Abstract

Hospital death is associated with poor-quality end-of-life care, and hospital is the most common death location for dementia patients. However, end-of-life care is inappropriate for dementia, which is not a terminal condition. In Japan, dementia patients receive long-term hospital treatment, with few opportunities to return home. Therefore, we examined the association between hospital death in dementia patients and regional provision of home-based end-of-life care. We analyzed 12,933 discharged dementia patients’ data from the National Patient Survey, a nationally representative cross-sectional survey examining hospital discharges. Number of patients covered by home-based end-of-life care clinics per 1,000 population in their residential regions were calculated using regional statistics. Of the 12,933 patients, 20.6% died in hospitals (average hospitalization duration: 160 days). Regional provision of home-based end-of-life care was associated with hospital death in dementia patients. However, patients in regions with high numbers of patients covered by home-based end-of-life care clinics were likelier to die in hospital than at home. Such care clinics were unsuccessful in providing end-of-life care. Furthermore, despite regional availability of home-based end-of-life care clinics, patients were likelier to die in hospital than at home. Therefore, specific strategies are needed to improve home-care clinics for dementia patients who require end-of-life care.

Keywords

• discharge outcome
• dementia
• place of death
• palliative care
• end-of-life care