Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study

Yi Chen Lai, Kang Ting Tsai, Chung Han Ho, Jung Yu Liao, Wei Zhe Tseng, Irene Petersen, Yi Chi Wang, Yu Han Chen, Hung Yi Chiou, Chao Agnes Hsiung, Sang Ju Yu, Elizabeth Lesley Sampson, Ping Jen Chen

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007–2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49–1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39–3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25–1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77–0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.

Original languageEnglish
Pages (from-to)2121-2130
Number of pages10
JournalInternal and Emergency Medicine
Volume18
Issue number7
DOIs
Publication statusAccepted/In press - 2023

Keywords

  • Acute healthcare utilization
  • Advance care planning
  • Dementia
  • End-of-life
  • Home healthcare

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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