Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study

Author:

Hamano Jun1ORCID,Shinjo Takuya2,Fukumoto Kazuhiko3,Kodama Maiko4,Kim Hongja5,Otomo Sen6,Masumoto Shoichi17,Hashimoto Kotaro8,Matsuki Takamichi9,Hisajima Kazuhiro10,Miyata Nobuyuki11,Suzuki Riri12,Yokoya Shoji113ORCID,Miyake Keijiro14,Takayanagi Ryo15,Shimizu Masakatsu16,Kataoka Yoshihiro1,Taira Hiroshi17,Ozone Sachiko1,Takahashi Hiroki18,Kizawa Yoshiyuki1

Affiliation:

1. Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

2. Shinjo-Clinic, Kobe, Hyogo, Japan

3. Iwata Home Care Clinic, Shizuoka, Japan

4. University of Fukui Hospital, Yoshida-gun, Fukui, Japan

5. Tottori University, Yonago, Tottoti, Japan

6. Seimeikan clinic, Sapporo, Hokkaido, Japan

7. Tsukuba Central Hospital, Tsukuba, Ibaraki, Japan

8. Fukushima Home Palliative Care Clinic, Fukushima, Japan

9. Fujisawa Zengyo Family Clinic, Fujisawa, Kanagawa, Japan

10. Dr. GON Kamakura Clinic, Kanagawa, Japan

11. Miyata Clinic, Tikusei, Ibaraki, Japan

12. Yamato Clinic, Sakuragawa, Ibaraki, Japan

13. Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan

14. Home Care Keijiro Clinic, Kagawa, Japan

15. Maebashi Kyoritsu Clinic, Maebashi, Gunma, Japan

16. Shimizu Medical Clinic, Akashi, Hyogo, Japan

17. Torimachi Clinic, Takasaki, Gunma, Japan

18. Kamisusaiseikai Hospital, Kamisu, Ibaraki, Japan

Abstract

Introduction/Objectives: There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. Methods: We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate). Results: In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009). Conclusions: The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.

Funder

Mitsubishi Foundation

Japan Society for the Promotion of Science

Publisher

SAGE Publications

Subject

Public Health, Environmental and Occupational Health,Community and Home Care

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