Where Do Elderly Patients Prefer to Die?

Abstract

This report describes the places of death of 100 elderly home-bound patients served by a home health care team. It compares some medical and psychosocial characteristics of the patients who died at home and the patients who died in an institution, and examines the factors that lead to death in an institutional setting for patients who had planned to die at home. All patients at the time of admission to team care had wished to receive care at home. The preferred place of death or type of care when death became imminent were not discussed at that time. Of the 100 patients who died, 55 died in their own homes and 43 died either in a hospital (33 patients) or in a nursing home (ten patients). Two patients died unexpectedly, either at home or on their way to the hospital. Sociodemographic variables such as age, sexual gender, Medicaid status, living arrangements, diagnosis, and pain level did not appear to be related to place of death. The patient's expressed wish for one or the other option seemed the key factor. Failure to provide death at home to 19 patients was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family.