Analysis of dying patterns of the elderly using medical care receipts

Abstract

[Purpose] Using the claim data of medical insurance and long term care insurance （ LTCI） from 5 local governments in Japan, we analyzed the service using pattern and morbidity of dying person in order to consider the ideal system for providing medical care and nursing care in order to improve the quality of recuperative life in the final stages of life. We attempted to visualize the utilization of medical and LTCI services during the end-of-life stage.

[Materials and methods] The claim data of medical insurance and LTCI from 5 local governments in Japan were used for the analysis. At first, the claim data were linked on an individual basis, and death cases aged 65 and over were extracted from this database. Next, starting from the year and month when death occurred （month of death, follow-up month number = 0）, the difference was calculated up to 24 months ago（ eg, -1 for the previous month）. For the deceased patients grasped above, the usage status of medical/LTCI services and the status of injuries and illnesses were grasped for each elapsed month using medical and LTCI claims.

[Results and discussion] This analysis clarified the following interesting finfings. First, the analysis results revealed that the progression of circulatory system failure symptoms such as heart failure and renal failure and the occurrence of pneumonia and aspiration pneumonia were important triggers for the pattern of injuries and diseases leading to death. Next, the prevalence of mood disorders was about 10% in the final stages of life, suggesting the need for mental health measures. Third, looking at the prevalence in the 24 months before death by age group, the prevalence of heart failure and dementia increased in the older group, while the prevalence of malignant tumors decreased. In the field of malignant tumor treatment, even in Japan, there is a long experience in hospice care, etc., so discussions on the way of care in the final stage of life are more advanced than in other fields. On the other hand, in the older group, it was shown that the importance of pneumonia and heart failure as a cause of death increased, rather than cancer being the direct cause of death. In addition, the number of subjects suffering from dementia is increasing with age, and in implementing Advance Care Planning （ACP） in the future, there may be a problem in selecting an advocate person.

[Conclusion] The results of this analysis indicate that the progression of circulatory system failure symptoms such as heart failure and renal failure and the occurrence of pneumonia and aspiration pneumonia are important triggers for the pattern of injury and disease leading to death. It is considered that the time before and after the symptoms of such a condition begin to appear is the timing to start the process related to ACP with the person concerned, including the family. In addition, it is considered necessary to widely provide the public with information on the pattern of these fatal injuries and illnesses so that the public can decide how to live in the final stages of their lives.