Comparison of medical treatments for the dying in a hospice and a geriatric hospital in Japan

Context: Most older adults who die in Japan do so in the hospital without receiving hospice or palliative care. While there are some hospices in Japan, little is known about the care they provide to the elderly. Objective: To clarify how the care of dying patients differs in a hospice and a geriatric hospital in Japan. Design: Cohort study. Setting: A hospice and a geriatric hospital in Japan. Participants: One hundred ninety-one inpatients aged 65 or older. Main outcome: Areas of our interest: (1) gender and age; (2) primary disease(s) and cause of death; (3) observed symptoms/conditions and medical treatment or care conducted within 48 hours prior to death; (4) the actual topics leading to disclosure; and (5) whether or not advance directives had been given. Results: The χ² test determined that there were statistically significant differences between a geriatric hospital and a hospice, with respect to mean age, diagnoses on admission, primary cause of death, symptoms/conditions, and the practice of medical interventions. However, controlling for patient characteristics and assuming a bivariate distribution between the probabilities of choosing a facility and of undergoing a medical procedure, we found that patients at the hospice were more likely to undergo treatment with opioids, urethral catheter, and oral medicine; such patients were less likely to undergo oxygen inhalation, total parenteral nutrition, and other intravenous drips. Conclusion: The hospice examined in this study was similar to the approach regarding medical treatments observed at the geriatric hospital.