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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
임은옥 (건강보험심사평가원) 김홍수 (서울대학교 보건대학원 보건학과)
저널정보
한국보건행정학회 보건행정학회지 보건행정학회지 제27권 제2호
발행연도
2017.1
수록면
167 - 176 (10page)

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초록· 키워드

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Background: This study aimed to analyze the impact of community health care resources on the place of death of older adults with dementia compared to those with cancer in South Korea, using public administrative big data. Methods: Based on a literature review, we selected person- and community-level variables that can affect older people's decisions about where to die. Data on place-of-death and person-level attributes were obtained from the 2013 death certification micro data from Statistics Korea. Data on the population and economic and health care resources in the community where the older deceased resided were obtained from various open public administrative big data including databases on the local tax and resident population statistics, health care resources and infrastructure statistics, and long-term care (LTC) insurance statistics. Community-level data were linked to the death certificate micro data through the town (si-gun-gu) code of the residence of the deceased. Multi-level logistic regression models were used to simultaneously estimate the impacts of community as well as individual-level factors on the place of death. Results: In both the dementia (76.1%) and cancer (87.1%) decedent groups, most older people died in the hospital. Among the older deceased with dementia, hospital death was less likely to occur when the older person resided in a community with a higher supply of LTC facility beds, but hospital death was more likely to occur in communities with a higher supply of LTC hospital beds. Similarly, among the cancer group, the likelihood of a hospital death was significantly lower in communities with a higher supply of LTC facility beds, but was higher in communities with a higher supply of acute care hospital beds. As for individual-level factors, being female and having no spouse were associated with the likelihood of hospital death among older people with dementia. Conclusion: More than three in four older people with dementia die in the hospital, while home is reported to be the place of death preferred by Koreans. To decrease this gap, an increase in the supply of end-of-life (EOL) care at home and in community-based service settings is necessary. EOL care should also be incorporated as an essential part of LTC. Changes in the perception of EOL care by older people and their families are also critical in their decisions about the place of death, and should be supported by public education and other related non-medical, social approaches.
#End of life care #Hospices #Dementia #Neoplasms #Hospital death #Big data

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참고문헌 (46)

참고문헌 신청
Houttekier D / 2010 / Place of death of older persons with dementia: a study in five European countries / J Am Geriatr Soc 58(4):751~756 Crossref Meeussen K / 2012 / Older people dying with dementia: a nationwide study / Int Psychogeriatr 24(10):1581~1591 Crossref Badrakalimuthu V / 2014 / Do people with dementia die at their preferred location of death?: a systematic literature review and narrative synthesis / Age Ageing 43(1):13~19 Crossref Ministry of Health and Welfare / 2013 / Announced survey of prevalence of dementia in 2013 google schola Van der Steen JT / 2014 / White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care / Palliat Med 28(3):197~209 Crossref

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