title: Study on the factors determining home death of patients during home care: a historical cohort study at a home care support clinic.
abstract: OBJECTIVE
  Associations between markedly low activities of daily living (ADL) at the start of home visit care and patient home death were analyzed using data from a home care support clinic in Japan that has a low rate of home deaths.
  
  
  METHODS
  The study was a historical cohort study. It involved patients who began to receive home visit care from a home visit care support clinic between 1 April 2006 and 31 March 2011. Using home death as a dependent variable and presence/absence of markedly low ADL and other parameters (cancer, the patient's desire for home death, etc.) as independent variables, the adjusted hazard ratio and 95% confidence interval (CI) were calculated using the Cox proportional hazards model.
  
  
  RESULTS
  Markedly low ADL were associated with home death even after adjustment for factors that influence home death (adjusted hazard ratio 4.40; 95% CI 2.37-8.16). Cancer and the patient's desire for home death were statistically significant factors involved in home death. In a subgroup analysis according to the presence/absence of cancer, the association between markedly low ADL and home death was stronger in the cancer-free group (adjusted hazard ratio 10.78; 95% CI 2.89-40.26) than in the cancer group (adjusted hazard ratio 5.58; 95% CI2.39-13.05).
  
  
  CONCLUSIONS
  Patients' desire for home death could be fulfilled if home care support clinics provide home visit services to not only terminal-stage cancer patients, but also bedridden cancer-free patients. We must establish systems for older adults to remain at home during the terminal period of their lives.
authors.affiliation: Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawagoe
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tsuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Doi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D003643:Death; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality
keywords: Cox proportional hazards model; Japan; activities of daily living; home death; home visit