Dataset Information

Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan.

ABSTRACT:

Objectives

To assess the association between receiving the certified care workers' home care service, which is provided by non-medical professionals prior to a patients' death and the probability of a home death.

Design

Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient's death per municipality as an instrumental variable.

Setting

The certified care workers' home care service covered by the public long-term care insurance (LTCI) system in Japan.

Participants

In total, 1?613?391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis.

Primary outcome measures

Death at home or death at other places, including hospitals, nursing homes and clinics with beds.

Results

Out of all participants, 173?498 (10.8%) died at home. The number of patients who used the certified care workers' home care service more than once per each month during 1, 2 or 3?months prior to the month of death numbered 213 848, 176?686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively.

Conclusions

The use of the certified care workers' home care service prior to death was associated with the increased probability of a home death.

SUBMITTER: Abe K

PROVIDER: S-EPMC6719756 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan.

Abe Kazuhiro K Miyawaki Atsushi A Kobayashi Yasuki Y Noguchi Haruko H Takahashi Hideto H Tamiya Nanako N

BMJ open 20190827 8

<h4>Objectives</h4>To assess the association between receiving the certified care workers' home care service, which is provided by non-medical professionals prior to a patients' death and the probability of a home death.<h4>Design</h4>Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient's death per municipality as an instrumental variable.<h4>Setting</h4>T ...[more]

PMID: 31462462

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Project description:ImportanceThe provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life.ObjectiveTo assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life.Design, setting, and participantsThis cohort study of older adults in Japan's long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020.ExposuresMean days of in-home care service used per week from the first day of the month before the month of death to the date of death.Main outcomes and measuresPrimary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014.ResultsOf the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points).Conclusions and relevanceThis retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.

Project description:With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

Dataset Information

Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan.

Objectives

Design

Setting

Participants

Primary outcome measures

Results

Conclusions

Publications

Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan.

Similar Datasets

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