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

ObjectivesTo determine the characteristics of nursing home residents that are associated with dying in a nursing home versus a hospital in Japan.DesignRetrospective case–control study.SettingA nonprofit nursing home with 110 beds in Tokyo, Japan.ParticipantsEighty-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.MeasurementsNursing 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.ResultsThe 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.ConclusionOlder 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.