Processes of decision making and end-of-life care for patients with dementia in group homes in Japan.

The aim of the present study was to clarify the processes of decision making and end-of-life care for patients with dementia in the group homes in Japan. We investigated 45 group homes for patients with dementia regarding cases of end-of-life care during a 3-year period between March 2004 and February 2007. Thirty-three cases from respondent group homes were collected. Patients had middle or advanced levels of dementia, with only six cases of confirmed wishes about the place of death. In most cases, managing directors confirmed family members' wishes (66.7%) and performed a central role in planning for end-of-life care (60.6%). About one-third of patients (36.4%) were able to eat by mouth until death. Intravenous feeding was mainly used when the patient was unable to take anything by mouth (51.5%). Methods of sustenance were usually previously decided by consulting with patient or families (45.5%). Approximately half of patients (54.6%) were attended by family members who stayed in the group home. Future research should examine the quality of end-of-life care in the group homes using evaluations of quality of life (QoL) for patients and family members.