2026 年 21 巻 3 号 p. 301-307
Objective: Evidence on advance care planning (ACP) in secondary-level emergency departments (EDs) in Japan is limited. We aimed to compare ACP status between home-dwelling and nursing-home older adults presenting to a secondary-level ED.
Patients and Methods: We conducted a retrospective cross-sectional study in a non-tertiary ED in a regional city, where 30% of residents were aged ≥65 years. Consecutive patients aged ≥75 years transported by ambulance and requiring admission during weekday daytime hours between January and July 2024 were assessed at admission using semi-structured interviews. We recorded ACP awareness, prior discussions on advance directives, treatment preferences, and do-not-attempt resuscitation (DNAR) status. Patients were stratified into home (Group H) and nursing home (Group N) residents. Multivariable logistic regression was conducted with consultation experience in AD (yes/no) as the dependent variable; independent variables were residential status (nursing home vs. home-dwelling), dementia, mobility, age, and sex.
Results: Of 161 patients, 75 were classified into Group H and 86 into Group N. Only seven (4.4%) recognized “ACP/Jinsei Kaigi”. Treatment wishes were confirmed in 28 patients (17%) overall and in six (7%) in Group N. Advance directives discussions were more common in Group N than Group H (58% vs. 19%, P<0.001), with higher proportions declining invasive treatment (85% vs. 63%, P=0.001) and selecting DNAR (84% vs. 60%, P=0.001). Adjusted analyses revealed independent associations of advance directives consultation with older age (adjusted odds ratio [aOR], 1.08; 95% confidence interval [CI], 1.02–1.14), dementia (aOR, 2.43; 95% CI, 1.03–5.73), and nursing-home residence (aOR, 2.96; 95% CI, 1.18–7.39).
Conclusion: ACP implementation remains low. Older age, dementia, and nursing home residence were independently associated with advance directives consultations. These findings may help identify patients who warrant structured ACP reviews; however, prospective multicenter studies are needed to confirm their clinical implications.
