2022 Volume 7 Pages 41-49
【Purpose】 From around 2030, when the baby boomer generation will reach the age of 80, the number of deaths will increase sharply in Japan. Therefore, considering how End-of-Life Care（ EOLC） should be is an urgent issue for society, and it is also indispensable for promoting Advance Care Planning （ACP）, which is currently being discussed. For this discussion, it is desirable to have a model case. Therefore, in this study, we examined the characteristics of patients admitted to an acute care hospital with bradyarrhythmia（ cardiac arrest） using medical and long-term care insurance（ LTCI） claims from four local governments in western Japan.
【Data and analysis method】 Data used for analysis are health and LTCI insurance claim data of patients aged 65 and over who were hospitalized in general hospitals （excluding tuberculosis wards） and long-term care hospitals in four municipalities in Japan from April 2011 to March 2018 with a diagnosis corresponding to bradyarrhythmia （cardiac arrest）. In this study, subjects were defined as those who used long-term care insurance services in the current and previous month of hospitalization in a general ward or long-term care ward with the above mentioned diagnosis. For these subjects, the status of use of medical and LTCI care services and the status of injuries and illnesses for one year before and one year after hospitalization were grasped and analyzed using a database that linked medical and LTCI claims on an individual basis.
【Results】 During the observation period, 15,147 cases were followed up for 1 year before and after hospitalization, with an average age of 85.5 years （standard deviation of 7.3 years） and a female ratio of 56.8%. The mortality rate was 65.3%, and 52.0% died during the month of admission. Looking at the month of admission, 74.8% were admitted to general wards. Looking at whereabouts before admission to a general ward one month ago, about 17% of those who were receiving institutional LTCI care services. In addition, 17.4% of the patients received home-visit medical care. When looking at the prevalence of injuries and diseases one month before, heart failure was the most common at 45.6%. Pneumonia accounted for 11.4% and aspiration pneumonia for 4.5%.
【Discussion】 Even if terminally ill elderly patients undergo cardiac arrest and are taken to hospital and given cardiopulmonary resuscitation, 50% die at discharge, and 65% die within a year. From the point of view of death with dignity, this kind of medical care is not necessarily what the person wants. In order to avoid such an inappropriate situation, it is necessary to practice ACP. There is a need for research practices that clarify the events that trigger the process.
