TY - JOUR
T1 - Mortality rate and its determinants among people with dementia receiving home healthcare
T2 - a nationwide cohort study
AU - Lai, Yi Chen
AU - Tsai, Kang Ting
AU - Ho, Chung Han
AU - Liao, Jung Yu
AU - Tseng, Wei Zhe
AU - Petersen, Irene
AU - Wang, Yi Chi
AU - Chen, Yu Han
AU - Chiou, Hung Yi
AU - Hsiung, Chao Agnes
AU - Yu, Sang Ju
AU - Sampson, Elizabeth Lesley
AU - Chen, Ping Jen
N1 - Funding Information:
This work was supported by the National Health Research Institutes [PH-108-GP-04 and PH-109-GP-04], and Chi-Mei and Kaohsiung Medical University Collaborative Project (110CM-KMU-07). The sponsor played no role in the design, methods, data collection, analysis, or preparation of this article.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Acute healthcare utilization
KW - Advance care planning
KW - Dementia
KW - End-of-life
KW - Home healthcare
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U2 - 10.1007/s11739-023-03319-3
DO - 10.1007/s11739-023-03319-3
M3 - Article
AN - SCOPUS:85160607957
SN - 1828-0447
VL - 18
SP - 2121
EP - 2130
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 7
ER -