{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:52:44Z","timestamp":1790013164276,"version":"4.0.1"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Context: A comprehensive plan has been launched by the Korean government to expand hospice and palliative care from hospital-based inpatient units to other services, such as palliative care at home, palliative consultation, and palliative care at a nursing home. Objective: To examine the illnesses and symptoms at the end of life associated with the place of death among older Korean adults. Methods: This secondary data analysis included a stratified random sample of 281 adults identified from the exit survey of the Korean Longitudinal Study of Aging aged \u226565 years and who died in 2017\u20132018. Results: Overall, 69% of the patients died at hospitals, 13% died at long-term care facilities (LTCF), and 18% died at home. In the multinomial logistic regression analysis adjusting for age, sex, and marital status, older adults who died in the hospital had higher odds (2.02\u20134.43 times) of having limitations in activities of daily living (ADL) as well as symptoms of anorexia, depression, weakness, dyspnea, and periodic confusion 1 month before death than those who died at home. Older adults who died in an LTCF were more likely to have limitations in ADL and instrumental ADL as well as a higher likelihood (2\u20135 times) of experiencing pain, anorexia, fatigue, depression, weakness, dyspnea, incontinence, periodic confusion, and loss of consciousness than those who died at home. Conclusion: Since the majority of subjects died either in a hospital or an LCTF, and this proportion is expected to increase, policy planning should focus on improving the palliative case in these settings. Future policies and clinical practices should consider the illness and symptoms of older patients at the end of life across different care settings.<\/jats:p>","DOI":"10.3390\/ijerph19073924","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T15:31:21Z","timestamp":1648222281000},"page":"3924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Illnesses and Symptoms in Older Adults at the End of Life at Different Places of Death in Korea"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4268-6437","authenticated-orcid":false,"given":"Su Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cheng, X., Yang, Y., Schwebel, D.C., Liu, Z., Li, L., Cheng, P., Ning, P., and Hu, G. (2020). Population ageing and mortality during 1990\u20132017: A global decomposition analysis. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003138"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jama.2018.8981","article-title":"Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000\u20132015","volume":"320","author":"Teno","year":"2018","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1136\/jech-2014-205365","article-title":"Place of death in the population dying from diseases indicative of palliative care need: A cross-national population-level study in 14 countries","volume":"70","author":"Pivodic","year":"2016","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"The Statistics Korea (2019). Preliminary Results of Birth and Death Statistics in 2018, The Statistics Korea.","DOI":"10.1787\/int_trade-v2018-2-21-en"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1089\/jpm.2019.0445","article-title":"Trends in Place of Death in a Super-Aged Society: A Population-Based Study, 1998\u20132017","volume":"23","author":"Koyama","year":"2020","journal-title":"J. Palliat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/08258597211036579","article-title":"Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study","volume":"37","author":"Ceylan","year":"2021","journal-title":"J. Palliat. Care"},{"key":"ref_7","unstructured":"The Ministry of Health and Welfare (2019). 1st Comprehensive Plan for Hospice and Palliative Care (2019~2023), The Ministry of Health and Welfare."},{"key":"ref_8","unstructured":"Oh, J.Y., Lee, D.H., Im, J.W., Shin, Y.J., Park, D.H., Yoo, H.R., and Choi, H.J. (2020). Policy for Improvement of Hospice and Palliative Care Service System, Health Insurance Review & Assessment Service."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Costa, V., Earle, C.C., Esplen, M.J., Fowler, R., Goldman, R., Grossman, D., Levin, L., Manuel, D.G., Sharkey, S., and Tanuseputro, P. (2016). The determinants of home and nursing home death: A systematic review and meta-analysis. BMC Palliat. Care, 15.","DOI":"10.1186\/s12904-016-0077-8"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1136\/bmj.38740.614954.55","article-title":"Factors influencing death at home in terminally ill patients with cancer: Systematic review","volume":"332","author":"Gomes","year":"2006","journal-title":"BMJ"},{"key":"ref_11","unstructured":"Meiner, S.E., and Lueckenotte, A.G. (2006). Gerontologic Nursing, Mosby Elsevier. [3rd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tay, R.Y., Choo, R.W., Ong, W.Y., and Hum, A.Y. (2021). Predictors of the final place of care of patients with advanced cancer receiving integrated home-based palliative care: A retrospective cohort study. BMC Palliat. Care, 20.","DOI":"10.1186\/s12904-021-00865-5"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.bulcan.2019.11.011","article-title":"Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: A French population based study","volume":"107","author":"Denis","year":"2020","journal-title":"Bull. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.jpainsymman.2019.01.014","article-title":"A Prospective Cohort Study of Factors Associated With Place of Death Among Patients With Late-Stage Cancer in Southern Africa","volume":"57","author":"Blanchard","year":"2019","journal-title":"J. Pain Symptom Manag."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Xu, W., Wu, C., and Fletcher, J. (2020). Assessment of changes in place of death of older adults who died from dementia in the United States, 2000\u20132014: A time-series cross-sectional analysis. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08894-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/jgs.16200","article-title":"Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States","volume":"68","author":"Cross","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dasch, B., Bausewein, C., and Feddersen, B. (2018). Place of death in patients with dementia and the association with comorbidities: A retrospective population-based observational study in Germany. BMC Palliat. Care, 17.","DOI":"10.1186\/s12904-018-0334-0"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.chest.2020.02.062","article-title":"Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States","volume":"158","author":"Cross","year":"2020","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/S2468-1253(18)30379-0","article-title":"Place of death and factors associated with hospital death in patients who have died from liver disease in England: A national population-based study","volume":"4","author":"Peng","year":"2019","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1177\/0269216316655747","article-title":"Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study","volume":"31","author":"Lovell","year":"2017","journal-title":"Palliat. Med."},{"key":"ref_21","unstructured":"Korea Empoyment Information Service (2020, August 01). About KLoSA. Available online: https:\/\/survey.keis.or.kr\/eng\/klosa\/klosa01.jsp."},{"key":"ref_22","unstructured":"Hall, S., Petkova, H., Tsouros, A.D., Costantini, M., and Higginson, I.J. (2011). Palliative Care for Older People: Better Practices, World Health Organization."},{"key":"ref_23","unstructured":"Kang, S.H., and Kim, H.R. (2021, July 21). Review on the Long-Term Care Service Insurance. Available online: http:\/\/www.kiri.or.kr\/pdf\/%EC%97%B0%EA%B5%AC%EC%9E%90%EB%A3%8C\/%EC%97%B0%EA%B5%AC%EB%B3%B4%EA%B3%A0%EC%84%9C\/nre2020-0129_2.pdf."},{"key":"ref_24","unstructured":"The Ministry of Health and Welfare in Korea (2021, July 21). Enforcement Decree Of The Long-term Care Insurance Act. Available online: https:\/\/elaw.klri.re.kr\/kor_service\/lawView.do?hseq=59577&lang=ENG."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Gao, W., Huque, S., Morgan, M., and Higginson, I.J. (2018). A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death. Healthcare, 6.","DOI":"10.3390\/healthcare6030107"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3924\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:43:16Z","timestamp":1760136196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,25]]},"references-count":25,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19073924"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19073924","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,25]]}}}