AUSTRALIA needs to rethink its approach towards caring for terminally ill and elderly patients, with new research finding that many people who are suited to palliative care spend their last days in hospital.

Using death registration data, researchers analysed the last year of life for 1071 Western Australians who had medical conditions amenable to palliative care such as cancer, chronic heart failure, HIV/AIDS or Alzheimer’s disease. (1)

The research, reported in the MJA as a rapid online publication, found that the patients were admitted to hospital, on average, eight times in their last year of life, for an average of 6 days per admission. Seventy per cent of the cohort had an emergency department visit.

The researchers questioned whether emergency departments were being used as a substitute for community care, and said health service delivery for the terminally ill needed more careful consideration.

“The heavy reliance on the acute-care system does not necessarily reflect the most appropriate use of resources for patients at the end of life,” the authors wrote.

The study also found that although the patients lived in the community, 62% of them spent the last day of their lives in hospital.

This contrasts with community preferences for place of death. An online survey released today by Palliative Care Australia as part of Palliative Care Awareness Week found that 74% of people who had thought about their preferred place of death wanted to die at home. (2)

Another rapid online article in the MJA reports a dramatic increase in the use of emergency ambulances, especially in people aged over 85 years, beyond that explained by demographic changes. (3)

The study analysed all emergency transportations (more than 2.2 million) in Melbourne over a 14-year period from 1994 to 2008.

The rate of emergency ambulance use per 1000 people increased from 32 to 58 during the 14-year study period. Among the 85+ age group, the rate of use per 1000 people increased from 248 to 474.

The researchers said that emergency transport use was an important determinant of emergency department attendance. The increase in ambulance use is likely to have “major effects” on acute hospital capacity, the authors wrote.

“In a climate of global financial constraint, we believe our results indicate an urgent need for a coordinated response by policymakers and service providers to this increasing demand,” they write.

The researchers called for more innovative models of out-of-hospital care, and suggested that health workers needed improved training to meet the special care needs of older Australians.

“This includes acknowledgement of limitations to care, especially with respect to aggressive treatment being inappropriate in very elderly and palliative-care patients.”

– Sophie McNamara

1. MJA 2011; May 23 (rapid online publication).

2. Palliative Care Australia: We need to talk about dying.
3. MJA 2011; May 23 (rapid online publication).

 

Posted 23 May 2011