The nursing home versus the hospital as the place of dying for nursing home residents in Japan

OBJECTIVES: To determine the characteristics of nursing home residents that are associated with dying in a nursing home versus a hospital in Japan. DESIGN: Retrospective case-control study. SETTING: A nonprofit nursing home with 110 beds in Tokyo, Japan. PARTICIPANTS: Eighty-six nursing home residents who died in the nursing home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. MEASUREMENTS: Nursing home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for nursing home end-of-life care, and presence of a full-time physician. RESULTS: The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for nursing home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the nursing home. CONCLUSION: Older age, the family's preference for nursing home end-of-life care, and the presence of a full-time physician were significantly related to dying in the nursing home versus in a hospital.