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Nursing homes and end-of-life care in Japan


Ikegami, Naoki, Ikezaki, Sumie


Journal Of The American Medical Directors Association, Volume: 14, No.: 10, Pages.: 718-723

Year of Publication



Objectives: To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the United States.; Setting: National sample of 653 nursing homes with responses from 371 (57%) on their facility characteristics, 241 (37%) on their resident characteristics, and 92 (14%) on the residents’ quality of life. All 5 hospitals in a city 80 miles from Tokyo cooperated.; Participants: Nursing home staff answered questionnaires on facility and resident characteristics. Resident level data were obtained from 1158. The questionnaire on the quality of care was responded to by 256 (63%) of the decedents’ families in nursing homes and 205 (48%) in hospitals.; Measurements: Facility characteristics included items on physicians, nurse staffing, and the facility’s end-of-life care policy. Resident characteristics included basic demographics, level of dementia, and resident’s and family’s preference for the site of death. The Toolkit was used to measure the quality of end-of-life care.; Results: The proportion of those dying within the nursing home was related to the facility’s policy on end-of-life care and the family’s preference. The quality of end-of-life care in nursing homes was generally better than in hospitals, and than in their respective counterparts in the United States.; Conclusion: Financial incentives by the Japanese government to promote end-of-life care in nursing homes may have contributed to increasing the proportion of deaths within the facility. The quality of care in nursing homes was evaluated as being better than hospitals.; Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Bibtex Citation

@article{Ikegami_2013, doi = {10.1016/j.jamda.2013.02.008}, url = {}, year = 2013, month = {oct}, publisher = {Elsevier {BV}}, volume = {14}, number = {10}, pages = {718--723}, author = {Naoki Ikegami and Sumie Ikezaki}, title = {Nursing Homes and End-of-Life Care in Japan}, journal = {Journal of the American Medical Directors Association} }


age distribution, aged, 80 and over, care, consumer behavior, dementia, endoflife care, epidemiology, family, female, financial incentives, humans, insurance longterm care, japan, male, manpower, medical staff, nursing homes, nursing staff, of, organizational policy, patient preference, quality, quality of care, quality of health care, questionnaires, sex distribution, statistics & numerical data, terminal care, toolkit, united states

Countries of Study

Japan, USA

Types of Dementia

Dementia (general / unspecified)

Types of Study


Type of Outcomes



Hospital Inpatient Care, Nursing Homes

Type of Interventions

End of Life Care

End of Life Care

Palliative Care