title: [Continuation of end-of-life care in a special elderly nursing home and the role of doctors].
abstract: OBJECTIVE
  As 2 years have passed since its implementation, and we have received several comments regarding our original article, we report the recent developments of end-of-life (EOL) care in a special elderly (SE) nursing home and describe the role of doctors.
  
  
  METHODS
  A total of 7 female EOL care patients (age, 101.5±4 years) in a special elderly home and 130 patients (98 years, 42 men, 88 women; age, 87±6.5 years) receiving palliative therapy in a hospital.
  
  
  RESULTS
  Four of the 7 EOL care patients died after an average of 480±297 days within our EOL care system, while 3 patients spent an average of 805±662 days in our SE home. Among the hospitalized patients, 93 (71.5%; 27 men and 66 women; age, 86.7±10 years) were able to be discharged to our facility, whereas 37 (28.5%; 15 men, 22 women; age, 86.4±11 years) died during hospital care. A number of patients who could discharge had a greater incidence of gastrointestinal disorders than congestive heart failure (p<0.05). Among 15 patients (≥98 years) who could not enter EOL care because of family problems, 12 were hospitalized and 9 died before discharge. This number was significantly greater than the number who died before discharge and who were <98 years (p<0.05). One patient (aged 103 years) who had a solid breast tumor successfully underwent surgery and was discharged after 3 days of admission, but she died within 90 days of EOL. The death rates in our nursing home were significantly lower than the average death rate in other facilities (15.3% vs. 37.2%, p<0.01).
  
  
  CONCLUSIONS
  Patients of over 98 years old did not live longer, despite hospitalized care; however, the number of patients (28%) who were less than 98 years could be discharged and were alive was significantly less than centenarians (p<0.05). Doctors in nursing homes should provide communication support for nursing homes and hospitals after providing medical education for care workers.
authors.affiliation: Fukuinkai Clinic.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurita
authors.forename: Naosuke
authors.initials: N
authors.lastname: Shinagawa
authors.forename: Eitarou
authors.initials: E
authors.lastname: Kodani
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Iwahara
authors.forename: Bonpei
authors.initials: B
authors.lastname: Takase
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kusama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009735:Nursing Homes; D010819:Physician's Role; D013727:Terminal Care