Summary
As the Australian population continues to age, it is increasingly important to understand how older individuals with life limiting conditions receive care as they approach the end of life. However, current national reporting provides only a limited view, particularly of the timing and setting of palliative care delivery.
This report uses linked data – aged care, public hospitals, Medicare-subsidised services and mortality – from the National Health Data Hub (NHDH) to examine variations in receipt of specialist palliative care for older people accessing aged care during the last year of life. It compares older people living in residential aged care with older people living in the community and using home care or residential respite care.
Key findings
In 2021–22, there were 132,000 people aged 65 and over who died from predictable deaths (not sudden deaths). Of these people:
- the median age at death was 85 years
- over half (56%) used at least one aged care service in the last year of life
- organ failure (47%) was the most common end-of-life disease trajectory
- almost 2 in 5 (38%) received specialist palliative care in the last year of life.
Receipt of specialist palliative care was higher among the younger age groups (50% of people aged 65–74) and people who died from cancer (60%).
The first specialist palliative care service in the last year of life usually occurred in the last two weeks of life (median of 12 days before death).
Just over 2 in 3 (68%) of these people had an unplanned hospital admission in the last year of life. This is an indicator of end–of–life care quality and may indicate gaps in symptom management or advance care planning.
At the time of death, 40% of the study population were in hospital (including emergency departments) and 36% were in residential aged care. Place of death offers insights into the settings of where end-of-life care was delivered, in lieu of measuring personal preferences.
People living in residential aged care in the last year of life, compared with people using home care and residential respite care, were less likely to:
- receive specialist palliative care (21% compared with 49%)
- receive their first specialist palliative care service earlier (8 days before death compared with 13 days)
- have an unplanned hospital admission in the last year of life (58% compared with 81%)
- be in hospital (including emergency departments) at the time of death (17% compared with 50%).