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Factors associated with place of death for elderly Japanese-American men: the Honolulu Heart Program and

Christina L Bell1, James Davis, Rosanne C Harrigan

  • 1Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817, USA. bellcl@hawaii.edu

Journal of the American Geriatrics Society
|January 30, 2009
PubMed

Insights

Elderly Japanese-American men were more likely to die in hospitals than in nursing homes, especially from dementia. Cultural factors may influence end-of-life care location decisions.

Area of Science:

  • Gerontology
  • Public Health
  • Sociology

Background:

  • Place of death reflects end-of-life health service use.
  • Asian Americans may experience higher hospital death rates than Caucasians, with unclear reasons.
  • Understanding place of death variations is crucial for healthcare planning.

Purpose of the Study:

  • To examine the distribution of death locations (hospital, home, nursing home) among elderly Japanese-American men.
  • To investigate associations between cause of death and place of death in this cohort.
  • To explore potential cultural influences on end-of-life care settings.

Main Methods:

  • Analysis of longitudinal data from the Honolulu Heart Program and Honolulu-Asia Aging Study (1991-1999).
  • Inclusion of 1,352 deceased men aged 73-99.
  • Examination of cause-of-death characteristics and location of death.

Main Results:

  • 59% died in hospitals, 23% at home, and 18% in nursing homes.
  • Dementia deaths: 43% hospital, 37% nursing home, 20% home (contrasting national data).
  • Stroke deaths: 53% hospital, 40% nursing home, 7% home. Cancer deaths: 53% hospital, 34% home, 13% nursing home.

Conclusions:

  • Higher hospital death rates and lower nursing home use in Japanese-American men may stem from cultural emphasis on home care and challenges accessing dementia care.
  • Family obligations and cultural attitudes towards end-of-life care, especially for dementia, warrant further investigation.
  • Findings highlight the need for culturally sensitive end-of-life care strategies.

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