Introduction: Although the number of deaths following a diagnosis of senility is increasing in Japan, the criteria of senility are unclear. Therefore, the purpose of this study was to investigate methods to diagnose senility in home medical care.Methods: We mailed questionnaires to 908 members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 535 members (58.9%) responded. Responses of 501 members who selected senility as the cause of death were analyzed. Most doctors considered "continuous care of the patient", "the patient's ADL and gradual decline in oral intake", and "the absence of other critical diseases" to be important when diagnosing senility. The items affecting a diagnosis of senility were "the family's understanding and opinions", "other diseases being medically excluded", and "contribution to the patient's QOL".Conclusion: In home medical care, many doctors consider continuity of care, gradual decline, and the absence of other critical diseases to be important when diagnosing senility. Non-medical aspects, such as the family's opinions and patient's QOL, affected the diagnosis.

Introduction: The purpose of this study was to investigate the immediate cause of death recorded by home medical care physicians on the death certificates of senile patients who died of pneumonia as a complication, and to examine physician-level factors related to selection of the cause of death.Methods: We used a mail questionnaire survey to conduct a cross-sectional study of members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 470 valid responses were received (response rate: 51.8%). The immediate cause of death was recorded as pneumonia in cases of complication by pneumonia "always" by 95 physicians (20.2%), "often" by 131 (27.9%), "sometimes" by 134 (28.5%), "rarely" by 91 (19.4%), and "never" by 19 (4.0%). Multivariate analysis revealed that female physicians were significantly less likely to record the immediate cause of death as senility (OR: 0.10, 95%CI: 0.01-0.71).Conclusion: The immediate cause of death recorded on death certificates varied in cases of senile patients who died of pneumonia as a complication. The present study also suggested that selection of the cause of death was influenced by the gender of physicians.