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Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study

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Abstract

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007–2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49–1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39–3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25–1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77–0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.

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Data Availability

The data for this study was obtained from the Health and Welfare Data Science Center (HWDC), Department of Statistics, Ministry of Health and Welfare, Taiwan (http://dep.mohw.gov.tw/DOS/np-2497-113.html). The application for permission to access the data was sent from National Health Research Institutes (NHRI) to HWDC and approved. But restrictions apply to the availability of these data, which were used under license for the NHRI and current study only, and so are not publicly available.

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Acknowledgements

This work was supported by the National Health Research Institutes [PH-108-GP-04 and PH-109-GP-04], and Chi-Mei and Kaohsiung Medical University Collaborative Project (110CM-KMU-07). The sponsor played no role in the design, methods, data collection, analysis, or preparation of this article.

Author information

Author notes

  1. Yi-Chen Lai and Kang-Ting Tsai have contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan

    Yi-Chen Lai

  2. Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

    Kang-Ting Tsai

  3. Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan

    Chung-Han Ho

  4. Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chung-Han Ho

  5. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan

    Jung-Yu Liao

  6. Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wei-Zhe Tseng & Ping-Jen Chen

  7. Department of Primary Care and Population Sciences, UCL, University College London, London, UK

    Irene Petersen

  8. Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan

    Yi-Chi Wang

  9. Department of Family Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan

    Yu-Han Chen

  10. Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan

    Hung-Yi Chiou & Chao Agnes Hsiung

  11. Taiwan Society of Home Health Care, Taipei, Taiwan

    Sang-Ju Yu

  12. Home Clinic Dulan, Taitung, Taiwan

    Sang-Ju Yu

  13. Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK

    Elizabeth Lesley Sampson

  14. Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK

    Elizabeth Lesley Sampson & Ping-Jen Chen

  15. School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ping-Jen Chen

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  1. Yi-Chen Lai
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Contributions

P-JC, Y-CL and K-TT contributed to the study conception and design, drafting of the article, C-HH, J-YL, and W-ZT contributed to the acquisition of data, analysis and interpretation of data, IP, Y-CW, and Y-HC contributed to the preparation of manuscript, H-YC, CAH, S-JY, ELS, and P-JC contributed to the critical revision, and final approval.

Corresponding author

Correspondence to Ping-Jen Chen.

Ethics declarations

Ethical approval

This is a nationwide cohort study using Taiwan’s National Health Insurance Research Database (NHIRD), which is a routinely collected, claim-based, and anonymised electronic record database, including the entire inpatient and ambulatory healthcare services between 2006 and 2017. In the NHIRD, information about any utilisation of NHI-reimbursed healthcare services or drug prescriptions for an individual is obtained by tracing specific administrative codes and is linked by an encrypted identification code. The study protocol was approved by the Research Ethics Committee of National Health Research Institutes in Taiwan (Approval No. EC1090305-E-R2).

Human and Animal Rights

This study does not involve human or animal participants, as it is an analysis of an anonymised database which has been routinely collected.

Informed consent

Informed consent was waived due to the anonymous nature of NHIRD analysis.

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The authors declare that they have no conflict of interest.

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Lai, YC., Tsai, KT., Ho, CH. et al. Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study. Intern Emerg Med 18, 2121–2130 (2023). https://doi.org/10.1007/s11739-023-03319-3

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