Factors Associated with Location of Death (Home or Hospital) : A Study of Elderly Persons Referred to a Public Visiting Nurse Service in the Metropolitan Tokyo

Abstract

As the home medical services develop, more old person themselves prefer to die and family caregivers prefer to have them die at home. Taking both the elderly and family's intention into consideration, purpose of the research is to examine factors related to location of death. The research was conducted at a public nursing office in the center of metropolitan Tokyo. Information was collected from all available nursing records of patients, among whom 59 died at home and 35 died wihtin 1 week of hospital admission between April 1993 and June 1997. The information collected comprises of demographic characteristics of elder patients and family, their expression to nurses about location of death and so on. Interview was carried out with the nurses in charge of all such person. Two major expressions to nurses used by elder person have sorted out by interview. One is "I never be hospitalized." another is "I want to be at home." Most frequent expression used by family caregiver is "I want to attend an old family at home until he dies." As for factors related to location of death of elder person, following five factors were found. 1. Malignant neoplasm or cardiac malfunction is the major sickness of the elderly. 2. The elder patients want to die at home and/or their family's desire to have them die at home. 3. Available home doctor. 4. A doctor in charge of the elderly is from a clinic or a private office, not from large scaled hospital. 5. Conversation held about the death of the elder patient among their home doctor, the elderly themselves and/or their family caregivers.