Relationship between pre-hospitalization home-based medical care of elderly patients who died from pneumonia and inpatient aggressive therapy in Japan

The number of elderly people aged 65 and over is increasing in Japan. Elderly, terminal patients in acute care hospitals receive aggressive therapy treatments, leading to higher national medical costs; however, reports indicate that patient discussions regarding end-of-life medical care can reduce unnecessary aggressive therapies. This study investigated whether the presence of home-based medical care impacted the use of aggressive therapies in terminal, elderly patients who had died of pneumonia during hospitalization. Japanese Diagnosis Procedure Combination (DPC) patient data were obtained for the period April 2014 to March 2017. We conducted a multicenter, cohort study of inpatients aged 65 years or older who were hospitalized for pneumonia and subsequently died. We analyzed the relationship between pre-hospitalization, home-based medical care, and aggressive therapies during the terminal stages of pneumonia using the chi-square test, t-tests, and logistic regression analyses. Data extracted included 13,582 cases of patients with pneumonia over the age of 65 years. The mean patient age was 83.1 (±7.02) years, 64.7% were male, 47.8% underwent ambulance transport, and 17.2% had home-based medical care. Aggressive therapy was administered in 33.3% of the cases. Effects of the independent variables on incidence of aggressive therapy were observed in 2,332 cases (17.2%; OR: 0.879; 95% CI: 0.791-0.977). Odds ratios were higher for patients undergoing ambulance transport, a higher Barthel index, and a higher A-DROP. We found that incidences of aggressive therapy during terminal stages of pneumonia were significantly lower for elderly patients who received home-based medical care prior to hospitalization.