title: Japanese Care Location and Medical Procedures for People with Dementia in the Last Month of Life.
abstract: BACKGROUND
  Dementia-related societies worldwide have called for palliative end-of-life care for those suffering dementia; meanwhile, the Japanese dementia plan was revised on January 2015 to introduce into its objectives the support for end-of-life care via increased social and health care collaboration.
  
  
  OBJECTIVE
  The study focus was the use of medical procedures in the last month of life among dementia patients in different care locations in Japan.
  
  
  METHODS
  This study was conducted using a retrospective study design. Data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey of the public long-term care insurance services, were used. The 6,148 patients who received end-of-life care in their own home, nursing homes, or hospitals in September 2007, 2010, and 2013 were included for analysis. The primary disease of each patient was based on the ICD-10 code; a diagnosis of dementia included F00 (Alzheimer's), F01 (vascular), F02 (other), and F03 (unspecified).
  
  
  RESULTS
  Of 6,148 patients, 886 (14.4%) had dementia as a primary disease; most received care in the last month of life in nursing homes (48.0%) or hospitals (44.8%) rather than in their own home (7.2%). Patients were less likely to undergo pain management when their primary disease was dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.21-0.91).
  
  
  CONCLUSIONS
  Education and policy efforts are required to provide palliative end-of-life care to people with dementia at home. The national dementia plan should also explore possible approaches regarding pain management for dying people who have dementia.
authors.affiliation: Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
authors.forename: Miharu
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Economics, Rutgers University, the State University of New Jersey, Camden, NJ, USA.
authors.forename: Taeko
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Division of Research, Tokyo Dementia Care Research and Training Center, Suginami-ku, Tokyo, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Niimura
authors.affiliation: Research Project for Mental Health Promotion, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D059408:Pain Management / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Dementia; hospice care; nursing homes; pain management; palliative care