In subgroup analysis of the types of
In subgroup analysis of the types of hospice as classified by the administrative authorities (Table 3), there was a trend that the patients admitted to a public hospital had a higher rate of dying in a hospice than those admitted to a private hospital, especially in the military and veterans\' hospitals. By contrast, the patients admitted to a private hospital had a trend of a higher rate of IDD, especially in religious corporation hospitals.
The factors significantly associated with IDD are shown in Table 4. After adjustments for each variable, binary logistic regression analysis showed that those with IDD were positively associated with older age (60–79 years) and shorter hospice stay. Compared with patients at the DOH/municipal hospitals, the patients with IDD were positively associated with private hospital systems, including private/enterprise corporation hospitals, religious corporation hospitals, and private university-affiliated hospitals. Compared with a department of internal medicine, being treated at other sections had the strongest association with IDD.
Discussion The place of death is viewed as a factor affecting the quality of end-of-life care in developed countries. It has been reported to vary depending on socioeconomic status, availability of health-care resources, and cultural background. In Europe, reports from Germany, Belgium, and Ireland have demonstrated an increasing trend of dying in an institution (hospice or nursing home), although dying in hospital still accounts for the majority of cases. In Mexico, however, as many as 52.9% of patients die at home, with deficiencies in health-care resources, advanced age, and suburban/rural residence being the predictive factors. Similar influencing factors have also been reported in Germany, Belgium, The Netherlands, and England. Support from buy strontium chloride and improved health-care resources have been reported to be beneficial for those dying at home. Enabling people to choose where they die is an important issue for high-quality end-of-life care. A previous study reported that most terminal patients consider their home as the preferred place of death. Therefore, expanding and improving palliative care at home may improve the quality of care and prevent unnecessary hospitalizations. However, few terminal patients actually die at home. Between 1990 and 1997, Tang and McCorkle found that 84–88% of terminal patients preferred to die at home, but only 17% actually did in 1995; the factors for turgor pressure are unclear. The main purpose of this study was to identify the relevant characteristics of places of death in terminal patients. In Taiwan, several population-based studies have discussed this issue. Tang et al performed a 6-year nationwide analysis of cancer patients, and found that most died in hospital. Lin et al investigated the role of the area of residence in the place of death, and found that, among the elderly and cancer patients, a low urbanized area was associated with dying at home. Both studies also suggested expanding the availability of palliative home care and hospice care to allow more patients to die at home. In the present study, patients with IDD had an older mean age (≥60 years), which is consistent with the finding of a previous population-based study. Interestingly, the proportion of patients aged 80 years and older was similar in both groups (19.8% vs. 19.2%). Further comparing the patients\' mean age and type of hospices for terminal admission, those admitted to a DOH/municipal hospital and veterans\' hospital had the highest mean age (71.1±13.5 years and 67.2±15.6 years, respectively). This may be because many elderly patients aged 80 years and over in Taiwan originally came to Taiwan during the Chinese Civil War in 1949, and many were servicemen. In 2014, the veterans accounted for 19.9% of all octogenarian deaths in Taiwan. These patients are more likely to use DOH/municipal hospitals and veterans\' hospitals, and thus in-hospice death is a more logical choice.