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Multicenter Study
. 2021 Jul 28;38(4):395-402.
doi: 10.1093/fampra/cmaa141.

Overall mortality in older people receiving physician-led home visits: a multicentre prospective study in Japan

Makoto Kaneko  1   2   3   4 , Takamasa Watanabe  1   2 , Yasuki Fujinuma  2 , Kenichi Yokobayashi  5 , Masato Matsushima  1
Affiliations
Multicenter Study

Overall mortality in older people receiving physician-led home visits: a multicentre prospective study in Japan

Makoto Kaneko et al. Fam Pract. .

Abstract

Background: Japan has the most rapidly ageing population in the world. The Japanese government has, therefore, promoted physician-led home health care for frail and disabled people.

Objectives: To describe mortality among older people receiving physician-led health care at home or at a nursing home in Japan and to identify risk factors.

Methods: This was a multicentre prospective cohort study. Participants were aged ≥65 years and had started to receive regular physician-led health care at home or at nursing homes from 13 facilities between 1 February 2013 and 31 January 2016. The observation period ended on 31 January 2017. We used a biopsychosocial approach for exploratory analysis of 13 variables to identify mortality risk factors.

Results: The median (25th to 75th percentile) observation time was 417 (121-744) days. Of 825 participants, 380 died. The total cumulative survival for 180, 360, 720 and 1440 days was 73.4% (95% confidence interval: 70.2-76.3), 64.2% (60.8-67.5), 52.6% (48.8-56.3) and 34.6% (23.5-46.0). The Kaplan-Meier cumulative survival curve showed a steep drop during the first 6 months of observation. A multivariate Cox proportional hazard model showed that sex (male), high Charlson Comorbidity Index score, low serum albumin level, low Barthel Index score, receipt of oxygen therapy, high Cornell Scale for Depression in Dementia score and non-receipt of public assistance were associated with mortality.

Conclusions: Overall mortality in physician-led home visits in Japan was described and mortality risk factors identified. Public assistance receipt was associated with lower mortality.

Keywords: Aged; cohort study; home care services; mortality; prospective studies; social welfare.

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Figures

Figure 1.
Figure 1.
Follow-up process for study participants receiving physician-led home visits in Japan, 2013–17.
Figure 2.
Figure 2.
Kaplan–Meier survival functions: total and by CCI category in older people receiving physician-led home visits in Japan, 2013–17. The total cumulative survival for 180, 360, 720 and 1440 days was 73.4% (95% CI: 70.2–76.3), 64.2% (60.8–67.5), 52.6% (48.8–56.3) and 34.6% (23.5–46.0).
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