FACTORS ASSOCIATED WITH PLACE OF DEATH FOR ELDERLY JAPANESE-AMERICAN MEN: THE HONOLULU HEART PROGRAM AND HONOLULU-ASIA AGING STUDY

摘要

Place of death is an indicator of health service utilization at the end of life and differs by cause of death. Asian Americans may have a higher percentage of hospital deaths than Caucasian Americans, yet reasons for this finding are unclear. This study examined distribution of place of death and the associations between place and cause of death among elderly Japanese-American men in a longitudinal cohort, the Honolulu Heart Program and Honolulu-Asia Aging Study. Data collected between 1991 and 1999 on 1352 men aged 73–99 years at death were analyzed for associations between cause-of-death characteristics and hospital, home, or nursing home location of death. Fifty-nine percent of men died in hospitals, 23% died at home, and 18% died in nursing homes. Of the dementia-related deaths, 43% occurred in hospitals (versus 16% in a national study), 37% occurred in nursing homes (versus 67% in a national study), and 20% occurred at home. Of the stroke deaths, 53% occurred in hospitals, 40% were in nursing homes, and 7% occurred at home. Of the cancer deaths, 53% occurred in hospitals, 34% occurred at home, and 13% were in nursing homes. Traditional family obligation to care for elders at home and inability to access care for dementia may account for the increased rate of hospital death and lower rate of nursing home deaths in this cohort. Attitudes of Japanese-American elders and their families regarding place of care at the end of life, particularly in the setting of dementia, merit future study.