[Current status of relocation among terminally ill older residents of nursing facilities: Observational study using anonymous long-term care receipt information].

Takumi Shirakata, Sayaka Tabuchi, Mikiko Ito, Katsuyuki Miura, Tomotaka Sobue
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Abstract

Objectives In Japan, efforts to provide "end-of-life care" in nursing homes are increasing and its introduction through long-term care insurance in 2006 is a major step forward. However, previous studies have shown that relocating older adults to their end-of-life care affects their burden. This study examined individuals' end-of-life care use under long-term care insurance in older care facilities and investigated the relocation frequency among terminally ill older residents of nursing facilities using receipt data.Methods The research targeted individuals aged ≥ 65 years under long-term care insurance who used formal end-of-life care services and were passed into residential facilities between April 1, 2018 and March 31, 2021. Data were obtained from anonymous long-term care certification information provided by the Ministry of Health, Labor, and Welfare. Six facilities providing end-of-life care were considered; older care facilities, geriatric health service facilities, designated establishments, and dementia group homes. A total of 233,735 individuals with service use records in the month of service cessation were aggregated according to facility, individual factors, and prefecture. Additionally, we defined end-of-life relocation as occurring if three categories of end-of-life care fees (day of death, 1-2 days before death, and 4-30 days before death) did not continue until the day of death.Results The participants were individuals aged ≥ 85 years (83.35%), 25.29% were men, and 93.53% required a care level of ≥ 3. Older nursing care facilities recorded the highest number (114,356) of end-of-life care users. The proportion of individuals with moderate-to-severe dementia (level ≥ IIIa; approximately 80%) was higher in nursing homes for older adults, community-based nursing homes for older adults, and dementia group homes than in other facilities. Relocation during the terminal phase was less prevalent in facilities with higher doctor and nurse staffing levels. At the individual level, relocation is more frequent among men, younger individuals, those with lower care levels, and those with intact decision-making and communication abilities. Conclusion Terminally ill residents aged ≥ 80 years with severe levels of care were the most likely to use end-of-life care. Moreover, 0.2-2% relocated across all facilities within 30 days before death. The relocation frequency increased based on individual factors and was mitigated by a thorough system of medical staff deployment.

[护理机构终末期老年居民搬迁的现状:使用匿名长期护理收据信息的观察性研究]。
在日本,在养老院提供“临终关怀”的努力正在增加,2006年通过长期护理保险引入这种服务是向前迈出的重要一步。然而,先前的研究表明,将老年人转移到他们的临终关怀会影响他们的负担。本研究以长期照护保险在老年照护机构中的使用情况为研究对象,并以收据资料为基础,探讨老年照护机构中罹患末期疾病者的搬迁频率。方法研究对象为2018年4月1日至2021年3月31日期间,使用正式临终关怀服务并进入养老院的≥65岁长期护理保险个体。数据来自厚生劳动省提供的匿名长期护理认证信息。考虑了六家提供临终关怀的机构;老年人护理设施、老年保健服务设施、指定机构和痴呆症群体之家。根据设施、个人因素和地区,汇总了在停止服务当月有服务使用记录的233,735人。此外,我们将临终搬迁定义为如果三种临终关怀费用(死亡当天、死亡前1-2天和死亡前4-30天)没有持续到死亡当天。结果参与者年龄≥85岁(83.35%),男性25.29%,护理水平≥3级(93.53%)。老年疗养设施的临终关怀使用者最多,达11.4356万人。中重度痴呆患者比例(≥IIIa级;老年人疗养院、社区老年人疗养院和痴呆症团体之家的死亡率比其他机构高约80%。在医生和护士配备水平较高的设施中,在终末阶段搬迁的情况不太普遍。在个体层面上,搬迁在男性、年轻个体、护理水平较低的个体以及决策和沟通能力完好的个体中更为常见。结论≥80岁、护理水平较重的临终病人使用临终关怀的可能性最大。此外,0.2% -2%的人在死亡前30天内在所有设施中迁移。重新安置的频率因个别因素而增加,但由于全面的医务人员部署制度而有所减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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