{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T02:26:55Z","timestamp":1768012015207,"version":"3.49.0"},"reference-count":38,"publisher":"BMJ","issue":"12","funder":[{"name":"JSPS KAKENHI through a Grant-in-Aid for Young Scientists"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine changes in places of dementia-related death following implementation of the national dementia plan and other policy initiatives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Japan between October 1996 and September 2016. Four major changes in health and social care systems were identified: (1) the public long-term care insurance programme (April 2000); (2) community centres as a first access point for older residents (April 2006); (3) medical care system for older people (April 2008) and (4) the national dementia plan (April 2013).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>9\u200960\u2009423 decedents aged 65 years or older whose primary cause of death was Alzheimer\u2019s disease, vascular or other types of dementia or senility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Place of death which was classified into \u2018hospital\u2019, \u2018intermediate geriatric care facility\u2019 (rehabilitation facility aimed at home discharge), \u2018nursing home\u2019 or \u2018own home\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The annual number of deaths at hospital was consistently increased over time from 1996 to 2016 (age-adjusted OR: 6.01; 95% CI 5.81 to 6.21 versus home deaths). Controlling for individual characteristics, regional supply of hospital and nursing home beds and other changes in health and social care systems, death from dementia following the national dementia plan was likely to occur in hospital (adjusted OR: 1.21; 95%\u2009CI 1.18 to 1.24), intermediate geriatric care facility (adjusted OR: 1.53; 95%\u2009CI 1.48 to 1.58) or nursing home (adjusted OR: 1.64; 95%\u2009CI 1.60 to 1.69) rather than at home.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>As the number of deaths from dementia increased over the decades, in-hospital deaths increased regardless of the national dementia plan. Further strategies should be explored to improve the availability of palliative and end-of-life care at patients\u2019 places of residence.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023172","type":"journal-article","created":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T09:32:31Z","timestamp":1545039151000},"page":"e023172","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6200-9279","authenticated-orcid":false,"given":"Miharu","family":"Nakanishi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syudo","family":"Yamasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,16]]},"reference":[{"key":"2020050713342470000_8.12.e023172.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31363-6"},{"key":"2020050713342470000_8.12.e023172.2","unstructured":"World Health Organization and Alzheimer\u2019s Disease International. 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