Unplanned hospital visits
Unplanned hospital visits in the last year of life, and especially in the final 2 weeks, are widely used as indicators of end–of–life care quality and health system performance and may indicate gaps in symptom management or advance care planning. It is important to note that people receiving specialist palliative care often have advanced, complex illnesses, increasing their need for urgent medical attention to respond to the severity of their condition, rapid symptom deterioration or complications.
In this section, unplanned hospital visits include emergency department presentations and unplanned hospital admissions (excluding private facility visits).
2 in 3 older people had unplanned hospital admission in the last year of life
Just over 2 in 3 (68%) people in the study population (aged 65 and over) had an unplanned hospital admission in the last year of life, and 30% in the 2 weeks before death.
People living in residential aged care were less likely to have an unplanned hospital admission in the last year of life compared with people using home care and residential respite care or people not receiving any of the selected aged care services (58%, 81% and 73%, respectively).
The average number of unplanned hospital admissions per person, in the last year of life, was lower for people living in residential aged care compared with people using home care and residential respite care (2.2 and 2.7, respectively).
3 in 4 older people visited the emergency department in the last year of life
Almost 3 in 4 (73%) people in the study population had an emergency department presentation in the last year of life, and 32% in the 2 weeks before death.
Fewer people living in residential aged care had an emergency department presentation in the last year of life, compared with people using home care and residential respite care and people not receiving any of the selected aged care services (65%, 84% and 77%, respectively).
Specialist palliative care recipients more likely to have unplanned hospital visit
People who received specialist palliative care were more likely to have unplanned hospital admissions in the last year of life compared with people who did not receive specialist palliative care (87% and 56%, respectively). These patterns may be influenced by factors such as specialist palliative care referrals during unplanned admissions, disease severity, comorbidities, and differences in healthcare use.
The same pattern was observed for emergency department presentations in the last year of life: 87% of people who received specialist palliative care compared with 64% of people who did not receive specialist palliative care.
These differences were more pronounced for people living in residential aged care compared with people using home care and residential respite care. Among people living in residential aged care, those who received specialist palliative care were 1.7 times as likely to have an unplanned hospital admission and 1.5 times as likely to have an emergency department presentation in the last year of life compared with those who did not receive specialist palliative care. Among people using home care and residential respite care, the ratio was 1.2 for both unplanned hospital admission and emergency department presentation.
Cancer patients more likely to have unplanned hospital visit in the last year of life
People who died from cancer were more likely to have an unplanned hospital admission in the last year of life compared with people who followed the organ failure trajectory and people who followed the frailty or dementia trajectory (75%, 67% and 51%, respectively).
In contrast, unplanned hospital admissions in the last 2 weeks of life, were slightly higher for people who followed the organ failure trajectory compared with people who died from cancer (31% and 28%, respectively), and lowest for people who followed the frailty or dementia trajectory (19%).
People who died from cancer and people who followed the organ failure disease trajectory had a higher average number of unplanned hospital admissions per person in the last year of life compared with people who followed the frailty and dementia trajectory (2.6, 2.4 and 1.9, respectively).
Similar patterns were observed for emergency department presentations in the last year of life and last 2 weeks of life.
Figure 6: Unplanned hospital and emergency department admissions in the last year of life, by end-of-life disease trajectories and aged care services, for study population, 2021–22
Chart shows unplanned hospital and emergency department admissions in the last year of life, by cause of death and aged care service use type
