title: Factors associated with home death for individuals who receive home support services: a retrospective cohort study.
abstract: OBJECTIVES: To determine the factors associated with a home death among older adults who received palliative care nursing home services in the home. METHODS: The participants in this retrospective cohort study were 151 family caregivers of patients who had died approximately 9 months prior to the study telephone interview. The interview focused on the last year of life and covered two main areas, patient characteristics and informal caregiver characteristics. RESULTS: Odds ratios [OR] and 95% confidence intervals [95% CI] were used to determine which of the 15 potential informal caregiver and seven patient predictor variables were associated with dying at home. Multivariate analysis revealed that the odds of dying at home were greater when the patient lived with a caregiver [OR = 7.85; 95% CI = (2.35, 26.27)], the patient stated a preference to die at home [OR= 6.51; 95% CI = (2.66,15.95)], and the family physician made home visits [OR = 4.79; 95% CI = (1.97,11.64)]. However the odds were lower for patients who had caregivers with fair to poor health status [OR = 0.22; 95% CI = (0.07, 0.65)] and for patients who used hospital palliative care beds [OR = 0.31; 95% CI = (0.12, 0.80)]. DISCUSSION: The findings suggest that individuals who indicated a preference to die at home and resided with a healthy informal caregiver had better odds of dying at home. Home visits by a family physician were also associated with dying at home.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Address: 105 Main St, E, Level PI, Hamilton, Ontario, L8N 1G6 Canada. brazilk@mcmaster.ca
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Michel
authors.initials: M
authors.lastname: Bedard
authors.forename: Kathleen
authors.initials: K
authors.lastname: Willison