Abstract
To clarify the patterns, reasons, and patient characteristics associated with emergency visits in the final 30 days of life for patients receiving home care in Japan. We conducted a retrospective analysis of emergency visits made by home care physicians to patients who died while receiving home care in 2018. Data on patient characteristics and emergency visits during the final 30 days of life were extracted from medical records. Poisson regression analysis was used to identify factors associated with emergency visit frequency. Among 83 end-of-life patients (median age 84 years, 49.4% male), a total of 86 emergency visits were recorded. These visits occurred most frequently in the days immediately preceding death, with 40.7% occurring within 5 days before death. Visits were more common during afternoons (37.2%) and weekends (39.6%). The primary reasons for visits included respiratory distress (20.9%), clinical assessment (14.0%), and neurological symptoms (12.8%). While some visits resulted in medication prescriptions (26.7%) or laboratory tests (22.1%), 36.1% involved observation only. Multivariable analysis revealed that longer duration of home care was associated with increased emergency visit frequency (31-365 days: relative risk [RR] 2.30, 95% confidence interval [CI]: 1.16-4.54; >365 days: RR 3.00, 95% CI: 1.56-5.78), while younger age was associated with increased visits (≤79 years: RR 2.04, 95% CI: 1.19-3.47). Emergency home visits in the terminal phase often clustered near death and frequently resulted in observation only, suggesting that some visits may be driven more by caregiver anxiety than medical urgency. Additionally, care level appeared to play a limited role during this period. These findings highlight the need for proactive symptom management, caregiver support, and scalable approaches such as telehealth to optimize end-of-life care.