Factors Associated with Place of Death for Elderly Japanese-American Men: The Honolulu Heart Program and Honolulu-Asia Aging Study

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 57; no. 4; pp. 714 - 718
• Main Authors: Bell, Christina L., Davis, James, Harrigan, Rosanne C., Somogyi-Zalud, Emese, Tanabe, Marianne K. G., Masaki, Kamal H.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-04-2009; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Asian Americans; Biological and medical sciences; Cause of Death; Chi-Square Distribution; Death & dying; Death Certificates; end of life; Ethics; ethnicity; General aspects; Geriatrics; Hawaii - epidemiology; Health services utilization; Home Care Services - utilization; Hospitals - utilization; Humans; Japan - ethnology; Japanese American; Japanese culture; Logistic Models; Longitudinal Studies; Male; Medical sciences; Mens health; Miscellaneous; Nursing Homes - utilization; Public health. Hygiene; Public health. Hygiene-occupational medicine; Residence Characteristics; site of death; Socioeconomic Factors; Asia; United States; North America; Japan; America; Hawaii; Honolulu Hawaii; Human; Heart; end of life; Senescence; Program; American; ethnicity; Ageing; Male; Japanese; site of death; Cause; Adult; Death; Circulatory system; Elderly; Japanese American; Public health
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.02149.x

Place of death is an indicator of health service utilization at the end of life and differs according to cause of death. Asian Americans may have a higher percentage of hospital deaths than Caucasian Americans, yet reasons for this finding are unclear. This study examined distribution of place of death and the associations between place and cause of death in elderly Japanese‐American men in a longitudinal cohort: the Honolulu Heart Program and Honolulu‐Asia Aging Study. Data collected between 1991 and 1999 on 1,352 men aged 73 to 99 at death were analyzed for associations between cause‐of‐death characteristics and hospital, home, or nursing home location of death. Fifty‐nine percent of men died in hospitals, 23% died at home, and 18% died in nursing homes. Of the dementia‐related deaths, 43% occurred in hospitals (vs 16% in a national study), 37% occurred in nursing homes (vs 67% in a national study), and 20% occurred at home. Of the stroke deaths, 53% occurred in hospitals, 40% were in nursing homes, and 7% occurred at home. Of the cancer deaths, 53% occurred in hospitals, 34% occurred at home, and 13% were in nursing homes. Traditional family obligation to care for elderly people at home and inability to access care for dementia may account for the greater rate of hospital death and lower rate of nursing home deaths in this cohort. Attitudes of elderly Japanese Americans and their families regarding place of care at the end of life, particularly in the setting of dementia, merit future study.