According to Gram Research analysis, 86% of Japanese hospital doctors report always or often having difficulty discharging elderly patients with advanced dementia to home for end-of-life care, and 73% struggle to place them in nursing facilities. Doctors who use more aggressive feeding methods, such as feeding tubes, report even greater difficulty with discharge. These barriers suggest that patients’ end-of-life care location may be influenced more by hospital practices and system limitations than by patients’ own preferences.
When older people with advanced dementia near the end of their lives, doctors often struggle to move them from hospitals to home care or nursing facilities. A new study of Japanese hospital doctors found that 86% have difficulty sending these patients home and 73% struggle to place them in long-term care facilities. The research shows that doctors who use more aggressive feeding methods, like feeding tubes, find it even harder to discharge patients. Understanding these barriers could help families and doctors make better end-of-life care plans that respect patients’ wishes.
Key Statistics
A 2026 cross-sectional survey of 301 Japanese hospital geriatricians found that 86% reported always or often experiencing difficulty discharging elderly patients with advanced dementia to home for end-of-life care.
Among the same 301 Japanese hospital doctors, 72.5% reported always or often struggling to place patients with advanced dementia in long-term care facilities for end-of-life care.
A 2026 study of 301 Japanese geriatricians found that doctors using more aggressive feeding interventions were 13% more likely to report difficulty with home discharge and 14% more likely to report difficulty with facility placement for patients with advanced dementia.
In a 2026 survey of 301 Japanese hospital-based geriatricians, caregiver-related factors were the most common barrier to home discharge for patients with advanced dementia, while facility-related factors were more common barriers to nursing home placement.
The Quick Take
- What they studied: Why hospital doctors find it difficult to move elderly patients with advanced dementia from hospitals to home or nursing facilities for end-of-life care
- Who participated: 301 Japanese hospital doctors who specialize in caring for older adults and have experience treating patients with senility (advanced dementia)
- Key finding: Most doctors (86%) report always or often having difficulty discharging these patients to home, and 73% struggle with placement in long-term care facilities. Doctors who use more aggressive feeding methods report even greater difficulty with discharge
- What it means for you: If you have an elderly family member with advanced dementia in a hospital, understanding these barriers can help you have better conversations with doctors about where end-of-life care should happen. This research suggests that some doctors may be hesitant to move patients out of hospitals, which is important to know when planning care
The Research Details
Researchers sent surveys to hospital-based geriatricians, which are doctors who specialize in caring for older adults, across Japan. They asked these doctors about their experiences discharging patients with senility, which is a medical term for advanced dementia or severe cognitive decline in older age. The doctors answered questions about what made discharge difficult and what methods they used to keep patients alive when they could no longer eat or drink normally. The researchers then analyzed the responses to find patterns between the doctors’ practices and how difficult they found discharge to be. This type of study, called a cross-sectional survey, takes a snapshot of what doctors are experiencing at one point in time rather than following patients over months or years.
Understanding what makes doctors hesitant to discharge patients is important because it can reveal whether the barriers are about the patient’s medical needs, the family’s ability to care for them, or the doctor’s own practices and beliefs. By identifying these barriers, hospitals and healthcare systems can work to remove them, allowing patients and families to have more choice about where end-of-life care happens. This matters because many people prefer to spend their final days at home or in familiar settings rather than in hospitals.
This study surveyed 301 doctors out of 850 contacted, which means about 35% responded. This response rate is moderate, so the results may not represent all Japanese geriatricians equally. The study was conducted in Japan, so findings may differ in other countries with different healthcare systems, family structures, and cultural attitudes toward end-of-life care. The study asked doctors about their perceptions and practices, not about actual patient outcomes, so we cannot be certain that the doctors’ reported difficulties directly affect where patients actually receive care.
What the Results Show
The study found that most hospital doctors in Japan struggle significantly with discharging elderly patients with advanced dementia. Specifically, 86% of doctors reported always or often having difficulty discharging these patients to home for end-of-life care, and 72.5% reported always or often having difficulty placing them in long-term care facilities. These high percentages suggest that discharge challenges are widespread among Japanese hospital geriatricians. The reasons for difficulty differed depending on where doctors wanted to send patients. When trying to discharge patients to home, doctors most commonly cited caregiver-related problems, such as family members not being able to provide care or not wanting to take the patient home. When trying to place patients in long-term care facilities, doctors more often mentioned facility-related problems, such as nursing homes being unwilling to accept patients with advanced dementia or not having available beds.
The study also examined how doctors’ medical practices related to their difficulty with discharge. Doctors were scored based on how often they used four aggressive feeding methods when patients could no longer eat or drink normally: giving fluids through an IV, providing nutrition through a central line (a tube placed in a major vein), using a nasogastric tube (a tube through the nose to the stomach), or performing a percutaneous endoscopic gastrostomy (a surgical feeding tube). Doctors who used these interventions more frequently reported greater difficulty discharging patients. For every increase in intervention frequency, doctors were 13% more likely to report difficulty with home discharge and 14% more likely to report difficulty with facility placement. This suggests that doctors who pursue more aggressive medical interventions may find it harder to transition patients away from hospital settings.
This research aligns with previous studies showing that end-of-life care for elderly patients with dementia often happens in hospitals rather than in community settings, even when patients or families prefer other locations. The finding that doctors’ medical practices influence discharge difficulty is relatively new and suggests that the way doctors approach keeping patients alive medically may shape where those patients ultimately receive care. Previous research has identified barriers to discharge, but this study is among the first to examine how doctors’ own intervention patterns may contribute to the problem.
The study has several important limitations. First, only 35% of surveyed doctors responded, so the results may not represent all Japanese geriatricians. Second, the study only asked doctors about their perceptions and experiences, not about what actually happened to patients, so we cannot be certain that perceived difficulty translates to actual discharge barriers. Third, the study was conducted in Japan, where healthcare systems, family structures, and cultural attitudes toward end-of-life care differ from other countries, so results may not apply elsewhere. Fourth, the study did not examine whether patients or families wanted discharge or preferred hospital care, so we cannot determine if discharge difficulty reflects appropriate medical decision-making or unnecessary barriers. Finally, the study is observational, meaning it shows associations but cannot prove that doctors’ interventions directly cause discharge difficulty.
The Bottom Line
Based on this research, families and healthcare teams should have early conversations about where end-of-life care for elderly patients with advanced dementia should happen, before the patient is in crisis. These conversations should include discussing what aggressive feeding methods the patient would want if they can no longer eat or drink. Healthcare systems should work to remove barriers to discharge by improving communication between hospitals and nursing facilities, training staff to care for patients with advanced dementia, and supporting family caregivers. Doctors should reflect on whether their use of feeding tubes and other interventions aligns with patients’ actual goals and preferences. Confidence in these recommendations is moderate, as the study identifies barriers but does not test solutions.
This research matters most to families with elderly relatives who have advanced dementia, doctors and nurses who care for these patients, nursing home administrators, and hospital administrators. It is especially relevant in aging societies like Japan, but the findings likely apply to other countries as well. If you are planning end-of-life care for an elderly family member with dementia, understanding these barriers can help you advocate for the type of care your family prefers. Healthcare policymakers should care about this research because it suggests that system-level changes could improve end-of-life care options.
Changes in discharge practices would likely take months to years to implement, as they require changes in hospital policies, nursing home practices, and doctor training. Families can start conversations about end-of-life preferences immediately, and these conversations may help doctors feel more confident about discharge planning. If barriers are removed at the system level, improvements in discharge rates could be seen within 6 to 12 months.
Frequently Asked Questions
Why do elderly patients with dementia stay in hospitals instead of going home at the end of life?
A 2026 study of 301 Japanese doctors found that 86% struggle to discharge these patients home due to caregiver limitations, family unwillingness, and doctors’ use of aggressive feeding methods. System barriers and lack of family support are major obstacles to home-based end-of-life care.
What makes it hard for nursing homes to accept patients with advanced dementia?
According to a 2026 survey of 301 geriatricians, facility-related barriers were the most common reason doctors struggled to place patients with advanced dementia in nursing homes, including facility unwillingness to accept these patients and lack of available beds.
Do feeding tubes affect where elderly patients with dementia receive end-of-life care?
Research from 2026 involving 301 Japanese hospital doctors shows that doctors using more aggressive feeding methods reported 13-14% greater difficulty discharging patients, suggesting feeding tube use may keep patients in hospitals longer.
How can families help elderly relatives with dementia receive end-of-life care at home?
Have early conversations with doctors about end-of-life preferences before crisis occurs. Discuss feeding tube decisions, arrange family support or hired caregivers, and document preferences in writing so all healthcare providers understand the patient’s goals.
What percentage of doctors find it difficult to discharge dementia patients to nursing homes?
A 2026 cross-sectional survey of 301 Japanese geriatricians found that 72.5% reported always or often experiencing difficulty placing patients with advanced dementia in long-term care facilities for end-of-life care.
Want to Apply This Research?
- Users caring for elderly relatives with dementia should track conversations about end-of-life care preferences, including where the patient would prefer to receive care (home, nursing facility, or hospital) and what medical interventions they would want. Record the date of conversations with doctors and family members, and note any barriers mentioned to achieving the patient’s preferred care setting.
- Start a conversation with your elderly relative’s doctor about end-of-life care preferences before a health crisis occurs. Ask specifically about what feeding methods the doctor would recommend if the patient can no longer eat or drink, and discuss whether those methods align with the patient’s goals. Document these preferences in writing so all healthcare providers are aware.
- Regularly review and update end-of-life care preferences as the patient’s condition changes. Track which healthcare providers (doctors, nurses, facility staff) are aware of these preferences. Monitor whether the patient’s actual care setting and medical interventions match the documented preferences, and raise concerns with the healthcare team if there is a mismatch.
This research describes doctors’ perceptions and experiences in Japan and may not apply to all healthcare settings or countries. The study does not provide medical advice for individual patients. If you are planning end-of-life care for an elderly family member with dementia, consult with your healthcare team to discuss options appropriate for your specific situation. Medical decisions about feeding tubes, nutrition, and care location should be made in consultation with qualified healthcare providers who know the patient’s medical condition and preferences.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.