Background
Research methods
Eligibility criteria
Quality assessment
Data extraction
Data analysis
Results
Author, year, sample size, country | Patient population, age (years) male | Type of diseasea | Place of death | NOS quality assessment scaleb |
---|---|---|---|---|
Poulose et al. 2013 [13] N = 842 Singapore | • Palliative home care team recipients • ≥65: 475 (56 %) • Male: 405 (48 %) | • Cancer: 729 (87 %) • Non-cancer: 113 (13 %) | • Home: 241 (29 %) • Hospital: 452 (54 %) • Inpatient hospice: 149 (17 %) | • 7 |
Seow et al. 2014c [36] N = 6,218 Canada | • Home care recipients • Median (IQR): 75: (64–84) • Male: 3,009 (48 %) | • Cancer: 4,950 (80 %) • Non-cancer: 1,268 (20 %) | • Outside of hospital: 4,828 (78 %) • Hospital: 1,390 (22 %) | • 7 |
Taylor et al. 2011 [17] N = 1,268 New Zealand | • Hospice care recipients • ≥55: 1,108 (88 %) • Male: 603 (48 %) | • Cancer: 1,036 (82 %) • Cardiovascular: 54 (4 %) • Respiratory: 45 (4 %) • Other: 120 (10 %) | • Home: 352 (28 %) • Hospital : 675 (53 %) • Nursing home: 203 (16 %) | • 7 |
Houttekier et al. 2011 [19] N = 189,884 Belgium | • General end-of-life population • ≥65: 54,311 (83 %)d • Male: 32,718 (50 %)d | Cause of death • Cancer: 18,321 (28 %)d • Cardiovascular:16,813 (26 %)d • Other: 30,100 (46 %)d | • Home: 14,726 (23 %)d • Hospital: 33,856 (52 %) d • Nursing home: 14,792 (23 %)d • Other: 2,061 (3 %)d | • 6 |
Ikezaki et al. 2011 [21] N = 4,175 Japan | • Receiving home care from nurses • Mean: 84 ± 10e • Male: 2,192 (53 %) | • Cancer: 1,664 (40 %) • Cardiovascular: 504 (12 %) • Pneumonia: 481 (12 %) • Other: 1,509 (36 %) | • Home: 1,930 (46 %) • Hospital: 2,245 (54 %) | • 7 |
Cardenas-Turanza et al. 2011 [22] N = 473 Mexico | • General end-of-life population • Mean (SD): 74 (73) • Male: 235 (50 %) | Cause of death • Cancer: 91 (19 %) • Cardiovascular: 104 (22 %) • Other: 278 (58 %) | • Home: 250 (53 %) • Hospital: 223 (47 %) | • 8 |
Fukui et al. 2011 [23] N = 568 Japan | • Receiving home palliative care from nurses • Mean (SD): 73 (12) • Male: 339 (60 %) | • Cancer: 100 % | • Home: 312 (55 %) • Hospital: 256 (45 %) | • 8 |
Hong et al. 2011 [12] N = 52,120 Singapore | • General end-of-life population • ≥65: 33,938 (65 %) • Male: 28,987 (56 %) | • Cancer: 100 % | • Home: 15,801 (30 %) • Hospital: 27,592 (53 %) • Inpatient Hospice: 5,592 (11 %) • Other: 3,135 (6 %) | • 6 |
Houttekier et al. 2010 [20] N = 1,690 Belgium | • General end-of-life population • ≥65: 1,462 (88 %) • Male: 839 (50 %) | Cause of death • Cancer: 725 (43 %) • Cardiovascular: 237 (14 %) • Other: 728 (43 %) | • Home: 402 (24 %) • Hospital: 664 (39 %) • Nursing home: 451 (27 %) • Palliative care unit: 171 (10 %) | • 7 |
Houttekier et al. 2010 [18] N = 237,579f Netherlands/England | • General end-of-life population • ≥70: 131,574 (73 %) • Male: 90,619 (50 %) | Cause of death • Cancer: 170,339 (72 %) • Heart failure: 11,599 (7 %) • Other: 52,454 (22 %) | • Home: 49,036 (21 %) • Hospital: 114,401 (48 %) • Nursing home: 39,256 (17 %) • Other: 34,886 (14 %) | • 6 |
Tang et al. 2010 [25] N = 201,252 Taiwan | • General end-of-life population • ≥65: 119,690 (59 %) • Male: 129,354 (64 %) | • Cancer: 100 % | • Home: 68,139 (34 %) • Hospital: 133,113 (66 %) | • 7 |
Hayashi et al. 2011 [26] N = 99 Japan | • Home care service recipients • Mean (SD): 78 (13) • Male: 49 (50 %) | • Cancer: 38 (38 %) • Ischemic heart disease: 19 (19 %) • Other: 42 (42 %) | • Home: 40 (40 %) • Hospital: 59 (60 %) | • 5 |
Bell et al. 2009 [27] N = 1,352 United States | • General end-of-life population • Mean: 84 • Male: 100 % | Cause of death • Cancer: 337 (25 %) • Coronary: 181 (13 %) • Other: 834 (62 %) | • Home: 306 (23 %) • Hospital: 800 (59 %) • Nursing home: 246 (18 %) | • 5 |
Lin et al. 2007 [29] N = 697,814 Taiwan | • General end-of-life population • ≥75: 423,552 (61 %) • Male: 290,394 (42 %) | • Cancer: 143,529 (21 %) • Circulatory: 185,679 (27 %) • Respiratory: 85,763 (12 %) • Other: 279,126 (40 %) | • Home; 459,005 (66 %) • Hospital: 238,809 (34 %) | • 7 |
Gruneir et al. 2007 [30] N = 1,402,167 United States | • General end-of-life population • ≥75: 810,453 (58 %) • Male: 671,638 (48 %) | Cause of death • Cancer: 351,944 (25 %) • Cardiovascular: 427,661 (31 %) • Other: 623,964 (44 %) | • Home: 330,447 (24 %) • Hospital: 740,405 (53 %) • Nursing home: 331,315 (24 %) | • 7 |
Motiwala et al. 2006 [32] N = 58,689 Canada | • General end-of-life population • ≥75: 43,071 (73 %) • Male: 27,749 (47 %) | • Cancer: 19,966 (34 %) • Dementia: 16,267 (28 %) • Other: 22,302 (38 %) | Not available | • 8 |
Cohen et al. 2006 [33] N = 55,759 Belgium | • General end-of-life population • ≥65: 46,271 (83 %) • Male: 28,248 (51 %) | Cause of death • Cancer: 15,008 (27 %) • Cardiovascular: 15,846 (28 %) • Other: 27,793 (45 %) | • Home: 13,549 (24 %) • Hospital: 29,943 (54 %) • Nursing home: 11,041 (20 %) • Other: 1,115 (2 %) | • 6 |
Brazil et al. 2005 [2] N = 214 Canada | • Home palliative care recipients • ≥50 year: 100 % • Male: 142 (66 %) | • Cancer: 207 (96 %) • Non-cancer: 7 (4 %) | • Home: 120 (56 %) • Institution: 94 (44 %) | • 8 |
Klinkenberg et al. 2005 [34] N = 270 Netherlands | • General end-of-life population • ≥80: 168 (62 %) • Male: 167 (62 %) | Cause of death • Cancer: 65 (24 %) • Non-cancer: 201 (76 %) | • Home: 135 (50 %) • Hospital: 86 (32 %) • Nursing home: 46 (17 %) | • 7 |
Aabom et al. 2005 [35] N = 4,386 Denmark | • Home residents • >65: 2,979 (68 %) • Male: 2,145 (49 %) | • Cancer: 100 % | • Home: 1,221 (28 %) • Hospital: 2,412 (55 %) • Nursing home: 702 (16 %) | • 7 |
Fukui et al. 2004 [24] N = 428 Japan | • Home care recipients • Mean (SD): 75 (11) • Male: 247 (58 %) | • Cancer: 100 % | • Home: 285 (67 %) • Hospital: 143 (33 %) | • 7 |
Author, year, sample size country | Patient population, age (years) male | Type of diseasea | Place of death | NOS quality assessment scaleb |
---|---|---|---|---|
Ikegami et al. 2012 [14] N = 1,158 Japan | • Nursing home residents • Mean (SD): 89 (8) • Male: 342 (30 %) | Cause of death • Cancer: 81 (7 %) • Cardiovascular: 220 (19 %) • Pneumonia: 237 (21 %) • Other: 620 (53 %) | • Nursing home: 548 (47 %) • Hospital: 610 (53 %) | • 6 |
Levy et al. 2012 [15] N = 7,408 United States | • Nursing home residents • Median (range): 78 (21–105) • Male: 7,224 (98 %) | Patients with different diseases, proportions not provided | • Hospital: 995 (13 %) • Nursing home: 6,413 (87 %) | • 6 |
Houttekier et al. 2011 [19] N = 79,846 Belgium | • General end-of-life population • ≥65: 54,311 (83 %)c • Male: 32,718 (50 %)c | Cause of death • Cancer: 18,321 (28 %)c • Cardiovascular:16,813 (26 %)c • Other: 30,100 (46 %)c | • Home: 14,726 (23 %)c • Hospital: 33,856 (52 %) c • Nursing home: 14,792 (23 %)c | • 6 |
Houttekier et al. 2010 [20] N = 1,690 Belgium | • Nursing home residents • ≥65: 1,462 (88 %) • Male: 839 (50 %) | Cause of death • Cancer: 725 (43 %) • Cardiovascular: 237 (14 %) • Other: 728 (43 %) | • Home: 402 (24 %) • Hospital: 664 (39 %) • Nursing home: 451 (27 %) • Palliative care unit: 171 (10 %) | • 7 |
Houttekier et al. 2010 [18] N = 237,579d Netherlands/England | • General end-of-life population • ≥70: 131,574 (73 %) • Male: 90,619 (50 %) | Cause of death • Cancer: 170,339 (72 %) • Heart failure: 11,599 (7 %) • Other: 52,454 (22 %) | • Home: 49,036 (21 %) • Hospital: 114,401 (48 %) • Nursing home: 39,256 (17 %) • Other: 34,886 (14 %) | • 6 |
Bell et al. 2009 [27] N = 1,352 United States | • General end-of-life population • Mean: 84 • Male: 100 % | Cause of death • Cancer: 337 (25 %) • Coronary: 181 (13 %) • Other: 834 (62 %) | • Home: 306 (23 %) • Hospital: 800 (59 %) • Nursing home: 246 (18 %) | • 5 |
Kwak et al. 2008 [28] N = 30,765 United States | • Nursing home residents • Mean (SD): 86 (8) • Male: 8,306 (27 %) | Cause of death • Cancer: 1,661 (5 %) • Cardiovascular: 11,291 (37 %) • Other: 17,844 (58 %) | • Home: 615 (2 %) • Nursing home: 21,228 (69 %) • Hospital: 8,307 (27 %) • Other: 615 (2 %) | • 7 |
Takezako et al. 2007 [31] N = 86 Japan | • Nursing home residents • ≥85: 53 (62 %) • Male: 20 (23 %) | • Cancer: 3 (4 %) • Cardiovascular: 20 (23 %) • Cerebrovascular: 35 (41 %) • Other: 28 (33 %) | • Nursing home: 43 (50 %) • Hospital: 43 (50 %) | • 8 |
Motiwala et al. 2006 [32] N = 58,689 Canada | • General end-of-life population • ≥75: 43,071 (73 %) • Male: 27,749 (47 %) | • Cancer: 19,966 (34 %) • Dementia: 16,267 (28 %) • Other: 22,302 (38 %) | • Not available | • 8 |
Levy et al. 2004 [16] N = 152,494 United States | • Nursing home residents • ≥65: 146,998 (96 %) • Male: not available | • Patients with different diseases, proportions not provided | • Hospital: 51,187 (34 %) • Nursing home: 101,307 (66 %) | • 7 |
Determinants of home death
Determinant | Number of Studies | Adjusted OR (95 % CI)b |
---|---|---|
Nurse Home Visits | ||
Nurse home visits in a general end-of-life population (vs. no visits) | 1 study | 2.78 (2.08–3.85) [35] |
Nurse home visits in home care recipients (vs. no visits) | 1 study | 3.13 (1.08–6.21) [26] |
Family Physician Home Visits | ||
Family physician home visits in a general end-of-life population (vs. no visits) | 1 study | 12.50 (8.33–16.67) [35] |
Family physician home visits in home care recipients | 2 studies | 1.74 (1.08–2.80) [23] |
4.42 (1.46–13.36) [2] | ||
Pooled: 2.01 (1.30–3.12), I2: 57 % | ||
Home Care Teams | ||
Multidisciplinary palliative home care team | 2 studies | |
Vs. usual carea | RR 2.17 (1.92–2.50) [36] | |
Vs. no multidisciplinary home care team | 8.40 (4.70–15.10) [20] | |
In-Hospital Palliative Care | ||
In-hospital palliative support team or hospice unit (yes vs. no) | 2 studies | 0.34 (0.10–0.90) [20] |
0.62 (0.40–0.96) [25] | ||
Pooled: 0.54 (0.33–0.89), I2: 18 % | ||
Preference for Home Death | ||
Patient preference for home death in a general end-of-life population (vs. no patient preference for home death) | 1 study | 14.20 (9.50–21.40) [20] |
Patient preference for home death in home care recipients (vs. no patient preference for home death) | 2 studies | 2.04 (1.48–2.80) [21] |
2.92 (1.25–6.84) [2] | ||
Pooled: 2.13 (1.58–2.87), I2: 0 | ||
Family preference for home death vs. no family preference for home death | 1 study | Non-cancer patients: 11.51 (8.56–15.99) [21] |
Cancer patients: 20.07 (12.24–32.91) [21] | ||
Congruence between patient and family preference vs. no preference congruence | 1 study | Non-cancer patients: 12.33 (9.51–15.99) [21] |
Cancer patients: 57.00 (38.79–83.76) [21] | ||
Disease-Related | ||
Major acute condition vs. other conditions | 1 study | 0.29 (0.26–0.33) [32] |
Timing of Referral to Palliative Care | ||
Time from referral to palliative care to death (≥1 vs. < 1 month) | 1 study | 2.21 (1.34–3.67) [13] |
Functional Status | ||
Worse functional status or bedridden (vs. better functional status or not bedridden) | 2 studies | 2.22 (1.27–3.87) [23] |
1.82 (0.93–3.57) [34] | ||
Pooled: 2.05 (1.33–3.15), I2: 0 | ||
Prior Hospital Admission | ||
≥ 1 hospital admission during the last year of life (vs. no admission) | 1 study | 0.15 (0.07–0.30) [22] |
Decision not to re-hospitalize in the event of a crisis (vs. no) | 1 study | 40.11 (11.81–136.26) [24] |
Informal Caregiver-Related | ||
Presence of informal caregiver (often vs. none or sometimes) | 1 study | 2.30 (1.20–4.60) [20] |
Low informal caregiver psychological distress during stable phase (vs. high distress) | 1 study | 5.41 (1.13–25.92) [24] |
Informal caregiver satisfaction with support from family physician (vs. dissatisfaction) | 1 study | 1.62 (0.31–8.62) [2] |
Informal caregiver health (excellent/very good vs. fair/poor) | 1 study | 0.64 (0.20–1.99) [2] |
Living Arrangements | ||
See Figure 4 |
Determinants of nursing home death
Determinant | Number of Studies | Adjusted OR (95 % CI)a |
---|---|---|
End-of-Life, Palliative or Hospice Care in the Nursing Home | ||
See Figure 5 | ||
Advance Directives | ||
Among nursing home residents | 1 study | 1.57 (1.35–1.82) [15] |
Any advance directive (vs. no advance directive) | ||
Do-not-resuscitate order (yes vs. no) | 1 study | 3.33 (3.33–3.45) [16] |
Do-not-hospitalize order (yes vs. no) | 1 study | 5.26 (4.76–5.88) [16] |
Preference for Nursing Home Death | ||
Among nursing home residents | ||
Patient preference (yes vs. no) | 1 study | 10.40 (4.40–24.90) [20] |
Family preference (yes vs. no) | 1 study | 16.62 (11.38–24.27) [14] |
Disease-Related | ||
End-stage disease (vs. non-end-stage) | 1 study | 3.90 (2.78–5.47) [15] |
Stroke vs. other diseases (nursing home residents) | 1 study | 1.12 (1.06–1.18) [16] |
Stroke vs. other diseases (general end-of-life population) | 1 study | 4.76 (2.38–9.09) [27] |
Heart Failure vs. other diseases (nursing home residents) | 1 study | 0.75 (0.65–0.88) [15] |
Diabetes vs. other diseases (nursing home residents) | 2 studies | 0.70 (0.61–0.81) [15] |
0.90 (0.87–0.93) [16] | ||
Pooled: 0.80 (0.63–1.03), I2: 91 % | ||
Functional Status | ||
Worse functional status or bedridden vs. better functional status or not bedridden (nursing home residents) | 2 studies | 2.80 (0.83–9.49) [31] |
2.22 (2.04–2.38) [16] | ||
Pooled: 2.22 (2.07–2.38), I2: 0 | ||
Nursing Home Characteristics | ||
Hospital-based nursing home (nursing home residents) | 1 study | 1.21 (1.15–1.25) [16] |
Full-time physician presence (nursing home residents) | 1 study | 3.74 (1.03–13.63 [31] |
Nursing Home Stay | ||
1-month increment (nursing home residents) | 1 study | 1.01 (1.01–1.01) [15] |
≥ 3 vs. < 3 months (nursing home residents) | 1 study | 1.44 (1.36–1.53) [28] |
Living Arrangements | ||
Living at home before nursing home (vs. not living at home) | 1 study | 2.97 (0.87–10.19) [31] |
Married vs. unmarried | 2 studiesb | 0.35 (0.07–1.64) [31] |
1.08 (1.00–1.16) [28] |