Perceived Difficulty in Discharging Older Patients With Senility to Home or Care Facilities for End-of-Life Care: A Nationwide Cross-Sectional Study of Hospital-Based Geriatricians in Japan.

BACKGROUND: Senility has become an increasingly common cause of death in aging societies such as Japan. However, many patients still die in hospitals, suggesting challenges in transitioning end-of-life care to community settings. This study examined hospital-based geriatricians' perceived difficulty in discharging patients with senility and associated physician-related factors. METHODS: I conducted a nationwide postal cross-sectional survey of hospital-based board-certified geriatricians in Japan. Perceived difficulty in discharge and its reasons were assessed. A composite intervention frequency score was calculated based on four clinical practices used when patients were unable to maintain oral intake (hydration, central venous nutrition, nasogastric tube feeding, and percutaneous endoscopic gastrostomy). Ordinal logistic regression analyses were performed to examine the association between intervention frequency and perceived difficulty, adjusting for physician characteristics. RESULTS: Of 409 respondents (response rate: 35.4%), 301 physicians with experience diagnosing senility were included. Most respondents reported experiencing difficulty in discharging patients with senility for end-of-life care to home (86.1% reported "always" or "often") and to long-term care facilities (72.5% reported "always" or "often"). Caregiver-related factors were prominent barriers to home discharge, whereas facility-related factors were more common for discharge to long-term care facilities. Higher intervention frequency was associated with greater perceived difficulty in discharge to home (OR 1.13, 95% CI 1.01-1.26) and long-term care facilities (OR 1.14, 95% CI 1.02-1.28). CONCLUSION: Hospital-based geriatricians frequently perceive difficulty in discharging patients with senility. Barriers differ by setting, and physicians' intervention tendencies may influence discharge planning.