title: Cumulative number of hospital bed days among older adults in the last year of life: A retrospective cohort study.
abstract: OBJECTIVE
  To determine whether age, proximity to death and long-term care insurance certification are related to receiving hospital inpatient care; the number of hospital bed days (HBD) among older Japanese adults in the last year of life; and to estimate the total number of HBD.
  
  
  METHODS
  Using health insurance claims and death certificate data, the present retrospective cohort study examined the HBD of city residents aged ≥65 years who died between September 2006 and October 2009 in Soma City, Japan. Using a two-part model, factors associated with receiving hospital inpatient care and the total number of HBD in each quarter in the last year of life were examined.
  
  
  RESULTS
  The total number of HBD in the last year of life varied widely; 13% had no admission, and 27% stayed ≥90 days. Younger age, approaching death and having long-term care insurance certification were significantly associated with being more likely to receive hospital inpatient care during each quarterly period in the last year of life. In contrast, having long-term care insurance certification and the last 3-month period before death, compared with the first 3-month period, were significantly associated with a fewer number of HBD.
  
  
  CONCLUSIONS
  The present study showed that older age was associated with being less likely to receive hospital inpatient care. The findings regarding the risk of inpatient care and total number of HBD in the last year of life help to understand resource use among older dying adults, and to develop evidence-based healthcare policies within aging societies. Geriatr Gerontol Int 2017; 17: 737-743.
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Shimmei
authors.affiliation: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Department of Health Management, Hyupsung University, Hwaseong, Gyeonggi, Korea.
authors.forename: Eun-Hwan
authors.initials: EH
authors.lastname: Oh
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Shimada
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakui
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Mori
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003644:Death Certificates; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007353:Insurance, Long-Term Care / Q000639:trends*; D007564:Japan; D008297:Male; D012189:Retrospective Studies; D013727:Terminal Care; D014505:Urban Population
keywords: aged; death; health resources; hospitalization; time factors