Exploring the influence of the impending death discharge tradition on home death rate in Taiwan

Background: As modern societies witness a shift from home deaths to hospital deaths, the compromise practice of impending death discharge (IDD) in response to Chinese traditions and changing times deserves further exploration. Methods: Using the Longitudinal Generation Tracking Database 2005, a validated cohort of two million randomly sampled National Health Insurance (NHI) beneficiaries, we conducted a retrospective analysis on the places of death for 123 832 individuals from 2008 to 2017. Results: Approximately 47.4% of the residents died in hospitals, 45.6% died in their own homes, and 2.4% died in long-term care facilities. Of those who died at home, 27 809 (49.2%) had undergone an IDD and were classified in the IDD group. Over the past decade, there has been a noticeable trend of decreasing home death rates. This trend is mainly due to the decline in the IDD group, which decreased from 29.6% in 2008 to 16.0% in 2017. The percentage of non-IDD group deaths that occurred at home ranged from 21.4% to 24.7%. The logistic regression analyses of all patients admitted to hospital before death revealed that individuals with IDD tend to be women, middle-aged individuals (aged between 50 and 79 years), married, and those residing outside of the six municipalities. Furthermore, the choice for IDD varied with the cause of death, with conditions like sepsis and malignancy recording higher rates as opposed to pneumonia. Patients who were discharged from hospice care were less likely to choose IDD. No association was found between choosing IDD and receiving hospice home care or emergency room visits in the year before death. Conclusion: This study investigates factors associated with IDD, informing healthcare professionals on end-of-life care in Chinese culture. Future qualitative or prospective research can offer deeper insights into family dynamics, patient preferences, and other unmeasured factors influencing IDD utilization.