[Medical services utilization of the elderly during the last six months of life]

The purpose of this study was to describe the characteristics of medical services utilization during the last six months of life. Subjects were 150 elderly who lived in a community and died in 1990. By each subject's medical claims during the last six months of life, the number of hospital days, the number of visits for ambulatory care, the number of physicians' and nurses' visits for home care, medical expenditure, and the utilization of medical care activities were measured as utilization variables. Subjects were classified into four subgroups by the combination of cancer and cerebrovascular disease. These diseases have an important impact on medical services utilization during the last six months of life. Utilization variables of each subgroup were compared. The findings were as follows; 1. During the last six months of life, hospital stays of cerebrovascular disease patients were for long periods, while cancer patients frequently and repeatedly changed the place of care between hospital and home. 2. The number of visits for ambulatory care and the number of medical care providers utilized by cancer patients were greater than that of cerebrovascular disease patients. Cerebrovascular disease patients whose stay at the hospital was short made greater use of physicians' and nurses' visit for home care. 3. The medical expenditure of cancer patients was higher than that of cerebrovascular disease patients, although the number of hospital days of cancer patients was less. 4. Most of the cancer patients utilized transfusion and urological treatment. These results suggest that the utilization of medical care activities of cancer patients was more intensive than that of cerebrovascular disease patients. However cancer patients made little use of resuscitation procedures.