Document Type : Original Article
Authors
1
Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
3
Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
4
Graduate Institute of Sports and Health Management, National Chung Hsing University, Taichung, Taiwan
5
Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
6
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
7
Department of Family Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
8
Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
9
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
Abstract
Background
Evidence is limited regarding place-of-death (PoD) differences across underlying cause-of-death categories and the associations of specialist palliative care and generalist home care utilization with PoD among older adults.
Methods
This population-based cross-sectional study included Taiwanese decedents aged ≥65 years from 2014 to 2023 with underlying causes of death eligible for palliative care reimbursement under National Health Insurance (NHI) regulations. Linked death registry and NHI claims identified underlying cause of death, specialist palliative care, and generalist home care utilization in the last year of life. PoD was the outcome, being classified as hospital, home, inpatient palliative care unit, long-term care facility, or other. The explanatory variables were underlying cause of death (cancer vs. non-cancer), specialist palliative care utilization, and generalist home care utilization in the last year of life. Their associations with PoD were examined using multinomial logistic regression, with hospital death as the reference category.
Results
Among 632 920 decedents (mean age, 81.03 years; 43.6% women), hospital (44.1%) and home (40.9%) were the most frequent PoD. From 2014 to 2023, home deaths declined from 46.1% to 38.5%, whereas hospital deaths increased from 42.1% to 44.6%. Decedents with underlying non-cancer causes (vs. cancer causes) had lower odds of home death (vs. hospital death; odds ratio [OR], 0.69; 95% confidence interval [CI], 0.68–0.70). Palliative home care was associated with substantially higher odds of home death (vs. hospital death; OR, 5.44; 95% CI, 5.30–5.58), whereas physician and nurse home visits showed more modest associations (OR, 1.40; 95% CI, 1.36–1.44 and OR, 1.12; 95% CI, 1.08–1.15, respectively).
Conclusion
PoD differences by underlying cause of death persisted, and palliative home care and generalist home care utilization were associated with higher odds of home rather than hospital death. These findings support evaluating needs-based referral and integrated home care models to broaden care options.
Keywords
