title: [Factors influencing the death of the elderly at home in an institution specializing home medical care--analysis of survey of the bereaved family].
abstract: OBJECTIVE
  To determine factors influencing on the death of the elderly at home in an institution specializing in-home medical care (home death rate: about 80%).
  
  
  METHODS
  This study was an anonymous mailed survey of bereaved families of patients (the caregivers) who died using the home medical care setting provided by an institution specializing in home medical care in Japan. We analyzed the relationship of demographics of the patients and the caregivers with such factors as the anxiety of the caregiver and eventual death at home, and that of such factors as perceived quality of home medical care by the caregiver, and satisfaction with home medical care, satisfaction with death bed nursing, regret for death bed nursing.
  
  
  RESULTS
  The most significant determinant factor associated with home death was that both patients and caregivers preferred death at home (OR=19.42). Determination coefficients (R(2)) in the multiple linear regression analysis of caregiver's satisfaction with home medical care, satisfaction with death bed nursing and regret for death bed nursing were as high as 0.68, 0.55 and 0.62, respectively. Significant influential factors were: peaceful death, psychological consistency of the caregiver, a good relationship with one's physician and fulfillment of the care service system.
  
  
  CONCLUSIONS
  Important components of home medical care and death bed nursing for the realization of death of the elderly at home are 1) peaceful death, 2) psychological consistency of caregivers, 3) a good relationship with one's physician, 4) fulfillment of the care service system.
authors.affiliation: Division of Heath Sciences, Osaka University Graduate School of Medicine.
authors.forename: Akiko
authors.initials: A
authors.lastname: Akiyama
authors.forename: Kumiko
authors.initials: K
authors.lastname: Numata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mikami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003643:Death; D005190:Family; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D007564:Japan; D008297:Male; D011787:Quality of Health Care; D011795:Surveys and Questionnaires