Preference for death at home and associated factors among older people in the city of Belo Horizonte, Brazil

Jorge, Rafaela; Calanzani, Natália; Freitas, Adelaide; Nunes, Rui; Sousa, Liliana

doi:10.1590/1413-81232018248.24102017

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FREE THEMES • Ciênc. saúde coletiva 24 (8) • Aug 2019 • https://doi.org/10.1590/1413-81232018248.24102017 copy

Preference for death at home and associated factors among older people in the city of Belo Horizonte, Brazil

Preferência por morrer em casa e fatores associados de pessoas idosas da cidade de Belo Horizonte, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We examined people’s preferences for place of death and identified factors associated with a home death preference. We asked a representative sample (N = 400) of older people (≥ 60 years) residents in the city of Belo Horizonte, about their preferences for place of death in a situation of serious illness with less than a year to live. Data were analyzed using binomial regression to identify associated factors. 52.2% indicate home as the preferred place of death. Five variables were associated with preference for death at home: those living with 1 child (odds ratio (OR)0.41; 95% confidence interval (CI):0.18-0.92; ref: without children); being in education for up to 4 years (OR0.42; 95% CI:0.20-0.89; ref: higher education); finding it difficult to live with the present income (OR3.18; 95% CI:1.53-6.62; ref: living comfortably); self-assessed fair overall health (OR2.07; 95% CI:1.06-4.03; ref: very good health) and selecting “choosing who makes decisions about your care” as the care priority that would matter to them the most (OR2.43; 95%CI:1.34-4.40; ref: dying in the place you want). Most respondents chose home as preferred place of death. However, most residents of Belo Horizonte die in hospitals, suggesting that preferences are not being considered.

Key words
Aged; Palliative care; Place of death; Brazil

Variables	n	%
Age group
60-69 years	217	54.3
70-79 years	121	30.3
80+	62	15.5
Gender
Female	241	60.3
Male	159	39.7
Education
No formal schooling	30	7.5
Up to 4 years	149	37.3
Up to 8 years	54	13.5
Up to 12 years	122	30.5
Higher education	45	11.3
Marital Status
Single	61	15.3
Married or with a partner	167	41.8
Separated/ Divorced	50	12.5
Widower	122	30.5
Religion
Roman Catholic	267	66.8
Protestantism/Evangelical	63	15.8
Spiritism/Afro-Brazilian	37	9.3
Other	11	2.8
No religion	22	5.5
Ethnicity
White	114	28.5
Black	63	15.8
Brown and other (1: Asian Brazilian; 1: Indigenous)	223	55.8
Activities in last 7 days
In education	26	6.5
Unemployed (actively looking for a job/ wanting a job but not actually looking for a job)	41	10.3
Permanently sick or disabled	5	1.3
In paid work	136	34.0
Retired	323	80.8
Pensioner	102	25.5
Housework, looking after children or others	34	8.5
Other	38	9.5
Financial hardship
Very difficult on present income	24	6.0
Difficult on present income	55	13.8
Coping on present income	207	51.7
Living comfortably on present income	114	28.5
Living with: adults
None (myself)	76	19.0
One adult	153	38.3
Two adults	98	24.5
Three adults	39	9.8
Four or more	34	8.5
Living with: children
None	351	87.8
One Child	34	8.5
Two or more	15	3.8
Health
Fair	76	19.0
Good	214	53.5
Very good	110	27.5
Experience of illness, death and dying
Close relative/friend seriously ill in last 5 years	299	74.8
Death of close relative/friend in last 5 years	270	67.5
Diagnosed with serious illness in last 5 years	76	19.0
Cared for close relative/friend in last months of life	264	66.0

First Preference for place of death	Age group						Total
	60-69		70-79		≥ 80		Total
	Male	Female	Male	Female	Male	Female	n	%
Home¹	59	54	21	35	12	28	209	52.2
Palliative care	17	21	12	13	3	5	71	17.8
Hospital	10	36	9	20	4	7	86	21.5
Long-term care facilities	7	13	5	6	0	3	34	8.5

Variables	n	%
Most important in the care available
Having as much information as you want	184	46.0
Choosing who makes decisions about your care	109	27.3
Dying in the place you want	107	26.8
Second most important in the care available
Having as much information as you want	135	33.8
Choosing who makes decisions about your care	153	38.3
Dying in the place you want	112	28.0

Variables	OR (95%-CI)	p-value OR	AOR (95%-CI)	p-value AOR
Age group (ref: 80+) 60-69 70-79	1.67 (0.93-3.00) 2.11 (1.12-3.97)	0.084 0.020	NS NS	0.272 0.072
Gender (ref. Man) Woman	1.46 (0.97-2.18)	0.068	NS	0.186
How many adults do you live with? (ref: none/myself) 1 adult 2 adults 3 adults 4 or more How many children do you live with? (ref: none) 1 child 2 or more	0.76 (0.44-1.32) 0.84 (0.46-1.53) 1.52 (0.69-3.33) 0.66 (0.29-1.51) 0.50 (0.24-1.06) 1.58 (0.55-4.53)	0.327 0.567 0.298 0.327 0.072 0.396	0.41 (0.18-0.92) 1.70 (0.55-5.22)	0.031 0.357
Marital status (ref: single) Married Married but separated Divorced Widower In a stable relationship	0.77 (0.43-1.39) 1.81 (0.49-6.66) 0.82 (0.36-1.84) 0.74 (0.40-1.38) 1.51 (0.33-6.89)	0.385 0.370 0.622 0.347 0.594
Religion (ref: no religion) Roman Catholic Evangelical Spiritist Other	0.70 (0.29-1.68) 0.98 (0.37-2.59) 0.64 (0.22-1.84) 1.46 (0.33-6.46)	0.425 0.963 0.402 0.619
Professional activity in the last 7 days Student (ref. No) Unemployed looking for a job (ref. No) Unemployed not looking for a job (ref. No) Permanently sick or disabled (ref. No) Paid work (ref. No) Retired (ref. No) Pensioner (ref. No) Housework (ref. No) Other	2.17 (0.94-5.00) 1.24 (0.47-3.29) 1.57 (0.68-3.63) 0.73 (0.12-4.40) 0.84 (0.55-1.27) 1.28 (0.77-2.11) 1.25 (0.80-1.97) 0.75 (0.37-1.53) 0.77 (0.40-1.53)	0.068 0.662 0.288 0.728 0.405 0.339 0.324 0.424 0.465	NS	0.083
Financial Hardship (ref: allows to live comfortably) Very difficult Difficult Coping	1.75 (0.72-4.24) 2.59 (1.33-5.03) 1.30 (0.82-2.07)	0.217 0.005 0.262	1.62 (0.60-4.36) 3.18 (1.53-6.62) 1.30 (0.78-2.16)	0.342 0.002 0.311
Health (ref: very good) Fair Good	1.68 (0.93-3.03) 0.92 (0.58-1.47)	0.089 0.736	2.07 (1.06-4.03) 1.00 (0.61-1.64)	0.025 0.991
Experience with illness, dying and death Family member or friend diagnosed with serious illness (ref: No) Closely experienced death of a family member/friend (ref. No) Received diagnosis of severe illness (ref. No) Involved in supporting close relative/friend in last months of life (ref. No)	0.96 (0.61-1.51) 1.00 (0.66-1.53) 0.71 (0.43-1.17) 0.95 (0.63-1.44)	0.859 0.987 0.178 0.823	NS	0.459
Education (ref: higher education or more) No formal schooling Up to 4 years Up to 8 years Up to 11 years	0.84 (0.33-2.12) 0.58 (0.30-1.14) 0.59 (0.26-1.30) 0.68 (0.34-1.36)	0.704 0.114 0.188 0.281	0.38 (0.13-1.10) 0.42 (0.20-0.89) 0.55 (0.23-1.30) 0.73 (0.35-1.52)	0.074 0.022 0.173 0.398
Ethnicity (ref: white) Black Brown (1 Asian Brazilian and 1 indigenous)	1.83 (0.98-3.42) 1.27 (0.80-2.00)	0.056 0.306	NS NS	0.065 0.233
Most important in the care available (ref: dying in the place you want) Having as much information as you want Choosing who makes decisions about your care Second most important (ref: dying in the place you want) Having as much information as you want Choosing who makes decisions about your care	1.28 (0.79-2.08) 1.75 (1.02-3.00) 0.83 (0.50-1.38) 1.12 (0.69-1.82)	0.309 0.041 0.479 0.656	1.34 (0.79-2.25) 2.43 (1.34-4.40)	0.277 0.004

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[1] Collaborations

All authors were involved in study design, survey development, cultural adaptation of the survey, data analysis, and took part in the interpretation of findings and manuscript preparation. R Jorge designed the study, administered the questionnaire, analyzed the results and wrote the manuscript. N Calanzani interpreted the data, revised and approved the manuscript. A Freitas analyzed and interpreted the data, prepared the article and approved the version to be published. R Nunes was involved in writing and reviewing the manuscript and approved the version to be published. L Sousa participated in the design of the study, analysis of results and writing of the manuscript.