Dataset Information

Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan.

ABSTRACT:

Objectives

To analyse the cognitive processes involved in the decision-making of older adults who are not in the end-of-life stage regarding the selection of a preferred place of death.

Design

A qualitative cross-sectional study based on semistructured in-depth interviews. The interview scripts were sectioned by context, then summarised, conceptualised and categorised. Post-categorisation, the relationships between the conceptual factors were examined.

Setting

Tama City, Tokyo, Japan, from November 2015 to March 2016.

Participants

20 long-term care users and their families or care providers were interviewed about their preferred places of death and the factors behind their decisions.

Results

Three categories based on the preferred place of end-of-life care and death were extracted from the interview transcripts: (A) discouraging the decision of a preferred place of death, (B) enhancing the desire for home death and (C) enhancing the desire for a hospital/long-term care facility death. Category A consists of concerns about the caregiver's health, anxiety about solitary death, and constraints of and concerns about the household budget. Both categories B and C consist of subcategories of reinforcing and inhibiting factors of whether to desire a home death or a hospital/long-term care facility death. If their previous experiences with care at home, a hospital or a care facility were positive, they preferred the death in the same setting. If those experiences were negative, they tend to avoid the death in the same setting.

Conclusions

One's mindset and decision regarding a preferred place of death include the consideration of economic factors, concerns for caregivers, and experiences of care at home or in a hospital/long-term care facility. Furthermore, health professionals need to be aware of the ambivalence of senior citizens to support their end-of-life decisions.

SUBMITTER: Tsuchida T

PROVIDER: S-EPMC9174769 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan.

Tsuchida Tomoya T Onishi Hitotaka H Ono Yoshifumi Y Machino Aco A Inoue Fumiko F Kamegai Manabu M

BMJ open 20220524 5

<h4>Objectives</h4>To analyse the cognitive processes involved in the decision-making of older adults who are not in the end-of-life stage regarding the selection of a preferred place of death.<h4>Design</h4>A qualitative cross-sectional study based on semistructured in-depth interviews. The interview scripts were sectioned by context, then summarised, conceptualised and categorised. Post-categorisation, the relationships between the conceptual factors were examined.<h4>Setting</h4>Tama City, To ...[more]

PMID: 35613762

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Project description:Background/objectivesAs home becomes the most common place of death in the United States, information about caregiver support and place of death is critical to improve patient and caregiver experiences at end of life. We seek to examine (1) the association between family care availability and place of death; and (2) caregiving intensity associated with place of death.Design2017 National Health and Aging Trends Study and National Study of Caregiving; nationally representative cross-sectional study of deceased older adults and last-month-of-life (LML) caregivers.SettingUnited States; all places of deaths.ParticipantsThree-hundred and seventy-five decedents and 267 LML caregivers.MeasurementsPlace of death (home, hospital, and nursing or hospice facility), family care availability (spouse/partner, household size, number of daughters and sons), caregiving intensity (hours of help provided at LML and a binary indicator for high care-related emotional difficulty).Results38.9% of older adults died at home, followed by hospital (33.1%), and nursing or hospice facility (28.0%). In an adjusted multinomial logistic regression, decedents with larger household size (odds ratio [OR]: 0.441; 95% confidence interval [CI]: 0.269-0.724) and more daughters (OR: 0.743 [95% CI: 0.575-0.958]) had lower odds of dying in nursing or hospice facility relative to dying at home. For older adults who died at home, caregivers provided 209.8 h of help at LML. In contrast, when death occurred in nursing or hospice facility, caregivers provided 91.6 fewer hours of help, adjusted for decedent and caregiver characteristics. Dying in hospital was associated with higher odds of caregiver emotional difficulty relative to home deaths (OR: 4.093 [95% CI: 1.623-10.323]).ConclusionsHousehold size and number of daughters are important determinants of place of death. Despite dying at home being associated with more hours of direct caregiving; caregiver emotional strain was experienced as higher for hospital deaths. Better support services for end-of-life caregivers might improve patient and caregiver experiences for home and hospital deaths.

Project description:BackgroundThe existing literature on nursing care for patients who choose home as their preferred place of death is scattered and lacks a coherent overview. This scoping review aimed to explore and categorize the available evidence on how nurses provide care for patients preferring to die at home.MethodsStudies that included nurses and were focused on nursing care for patients who choose the home as their preferred place of death were included in the review. The scoping review considered studies with quantitative, qualitative, or mixed method designs; systematic reviews; and meta-analyses. No time restrictions were added. Key information sources were Medline, CINAHL (EBSCO), Scopus (Elsevier) and Google Scholar. Systematic reviews were searched for in the Cochrane Database of Systematic Reviews. Unpublished studies and grey literature were searched for in ProQuest Dissertations and Theses. The reference list of the studies included was searched.ResultsA total of 13 studies were deemed eligible for inclusion in the review, of which (n = 11) were qualitative and (n = 2) were both qualitative and quantitative. The studies were published between 2008 and 2023 and were conducted in the United Kingdom (n = 5), Norway (n = 4), Australia, Sweden, Canada and Japan. The studies included in this review highlighted issues of competence, resource limitations, flexibility as a coping mechanism, as well as collaboration and family caregivers.ConclusionsThis review identified significant challenges in delivering nursing care for patients who prefer to die at home, including staff shortages, resource limitations, and educational deficiencies. Despite these barriers, nurses showed a strong commitment to patient care, highlighting the need for increased support and collaboration with family caregivers to improve home-based end-of-life care.Implications for researchTo improve care for patients who wish to die at home, it is crucial to address staff shortages and enhance nurse training to close knowledge gaps and ensure consistent, high-quality care. Healthcare systems must also allocate adequate resources to ensure that nurses have the necessary tools to deliver safe and effective care in home settings. Strengthening interdisciplinary collaboration will further enhance patient outcomes by supporting both nurses and family caregivers in end-of-life care.

Dataset Information

Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan.

Objectives

Design

Setting

Participants

Results

Conclusions

Publications

Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan.

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