Aims
Home medical care plays an important role to provide medical care for homebound community-dwelling older adults who may be at a stage of limited life expectancy. The study aimed to reveal the backgrounds about end of life (EOL) stage for older adults who received home medical care in Japan.
Methods
Inclusion criteria for the study were 1) age≥65 years, 2) who received home medical care services and died between April 2016 to October 2022 in one home medical clinic in Tokyo, Japan. Data were extracted based on medical records: age, gender, underlying diseases, number of medications, level of long-term care (LTC) needs, profile of family members, advance care planning, emergency department visits, hospital admission, place of death, and cause of death.
Results
89 patients were identified (mean age 91.7±7.3, female 67 %). Deprescribing of medication was observed, mostly due to deterioration of swallowing function towards EOL. Although the emergency department visits were rare, the visits mostly led to hospitalization. For the place of death, home was the most common, followed by hospital, and nursing homes. While the goals of care were achieved for more than half of the patients, some patients changed their preferences about the treatment or living arrangement towards EOL. Advance care planning was observed from 2016 to 2019, but decreased after 2020.
Conclusions
The study showed the detailed information about older adults who received home medical care in EOL stage, which could contribute to appropriate decision-making about EOL.