Characteristics of the decedents (N = 1,565).

BackgroundEven though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea.ObjectivesThis study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea.MethodsThis secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults.ResultsAmong 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death.ConclusionThe findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children’s financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.背景 尽管已有研究表明，居家死亡可提升生命质量、提高患者与家属的满意度，并降低医疗支出，但目前学界对韩国境内影响居家死亡的相关因素仍知之甚少。 本研究旨在探讨韩国中老年人群居家死亡的相关影响因素。 本研究为二次数据分析，所用数据源自2008至2018年间开展的韩国老年纵向研究（Korean Longitudinal Study of Aging, KLSA）的核心访谈与临终访谈数据集。研究对象为45岁以上的已故成年人。自2008年起，研究团队每两年对逝者的家属或其他熟识者开展访谈以获取临终访谈数据。本研究共纳入1565名中老年已故受试者，采用复杂抽样logistic回归模型进行统计分析。 在1565名已故受试者中，居家死亡组的平均死亡年龄为80.67±10.69岁，非居家死亡组为78.72±9.83岁。居家死亡占总死亡案例的比例为26.4%。分析结果显示，年龄超过81岁与居家死亡的发生风险升高相关；而拥有2名及以上在世子女、居住于城镇或小城市、由子女/孙辈及其配偶支付医疗费用、预知死亡结局、因疾病死亡以及罹患3种及以上慢性病，则与居家死亡的发生风险降低相关。死亡前3个月的日常生活活动能力（Activities of Daily Living, ADL）提升，与居家死亡概率降低存在关联。 本研究结果可为医疗从业者制定个性化干预方案提供参考，帮助其依据家属特征与医疗可及性，协助民众实现其偏好的死亡地点选择。年龄、居住地区、子女数量及子女的经济支持、疾病相关因素均通过影响医疗资源获取与支持程度，对居家死亡产生作用。政策制定者应缩小医疗资源分配差距，优化健康资源配置并完善居家照护服务。