• Mirika Hirano, Misako Ogiwara, Yasunori Sakamoto, Kiyotaka Yamagiwa, Kyoko Moriguchi, and Setsu Iijima.
• Shalom Special Elderly Nursing Home.
• Nihon Ronen Igakkai Zasshi. 2011 Jan 1;48(5):509-15.

AimWe investigated the characteristics of people who died in a special elderly nursing home and the current status of end-of-life decision-making.MethodsSubjects comprised 168 residents who were discharged from a special elderly nurshing home in Yokohama between April 1998 and June 2008. A total of 3 patients were excluded from this study due to insufficient inclusion criteria. We collected and retrospectively examined the basic descriptive information regarding the terminal phase of care from medical records, death certificates, and the notes of nurses, caregivers and counseling staff.ResultOf a total of 165 subjects comprising 38 men (23%) and 127 women (77%), 30 (18%) died in a nursing home facility (facility mortality group), 101 (61%) died in hospitals (hospital mortality group) and 34 (21%) were discharged from special elderly nursing homes for transfer to long-term hospitalization (hospitalization group). To clarify the factors which led to death within the facilities, we analyzed: 1) age at discharge, 2) sex, 3) residency period, 4) number of hospitalizations, 5) length of hospital stay, 6) number of children, 7) number of conferences regarding end-of-life care in 2 groups: the facility mortality group and all others as the second group, as explanatory variables on multiple discriminant analysis. This revealed a higher number of conferences, a higher age at discharge, and a smaller number of hospitalizations in the facility mortality group. Only 12 (7%) people were able to convey by themselves how they wanted to spend the remainder of their lives, and 61 (37%) people conveyed this information via family members. However, 100 (61%) people were unable to confirm it by either self-report or family members.ConclusionThe people who died in special elderly nursing homes had a higher age, fewer hospitalizations, and had been involved in more conferences regarding terminal care. However, it was very hard to confirm individual intentions regarding terminal care periods. Further studies will be necessary to determine what kind of terminal care is needed in special elderly nursing homes when it is difficult to confirm individual or family intention regarding the terminal period.

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