The interface between Aged Care and Palliative Care: and Palliative Care: Friend or Foe?
A/Prof Jenny Schwarz FRACP, Grad Dip Ed, Grad Dip Pall Med
“A considerable body of evidence shows that older people suffer unnecessarily, unnecessarily owing to widespread under assessment and under treatment of their problems and lack of access to p p palliative care.” Dr A Tsouros Head, Centre for Urban Health WHO Regional Office for Europe in Better Palliative Care for Older People WHO 2004
Aged Care and Palliative Care Aged Care g Maximize function Symptom control Support families Respite care End of life care
Palliative Care Maximize function Symptom control Support families Respite care End of life care
Residential care Residential care
Hospice care Hospice care
Aged Care meets Palliative care: Friend or Foe?
Better Palliative Care for Older People WHO 2004 • Traditionally, high quality care at the end of life has mainly y, g q y y been provided for cancer patients in hospices
Better Palliative Care for Older People WHO 2004 • Traditionally, high quality care at the end of life has mainly y, g q y y been provided for cancer patients in hospices • 25% of all deaths are due to cancer
Better Palliative Care for Older People WHO 2004 • Traditionally, high quality care at the end of life has mainly y, g q y y been provided for cancer patients in hospices • 25% of all deaths are due to cancer • 75% of deaths from cancer occur in people aged over 65
Better Palliative Care for Older People WHO 2004 • Traditionally, high quality care at the end of life has mainly y, g q y y been provided for cancer patients in hospices • 25% of all deaths are due to cancer • 75% of deaths from cancer occur in people aged over 65 • 73% of cancer patients 80 (Australian data) services compared with 58% of those > 80 (Australian data)
Better Palliative Care for Older People WHO 2004 • Traditionally, high quality care at the end of life has mainly y, g q y y been provided for cancer patients in hospices • 25% of all deaths are due to cancer • 75% of deaths from cancer occur in people aged over 65 • 73% of cancer patients 80 (Australian data) services compared with 58% of those > 80 (Australian data) • 30% of hospice inpatients have non‐cancer illnesses (cardiac failure, COPD, stroke, dementia & renal failure)
Illness trajectories j
Adapted from: Lynn J, Adamson DM. Living well at Adapted from: Lynn J Adamson DM Living well at the end of life; adapting health care to serious chronic illness in old age. Arlington, VA, Rand Health, 2003
“The defining characteristic of our time seems to be that we are both younger longer and older longer; we are more vigorous at ages that once seemed very old and we are far more likelyy to suffered p protracted periods of age‐related disability and dependence because we live to ages that few people reached in the past.”
The President’s Council on Bioethics (accessed07/07/2011) http://bioethics.georgetown.edu/pcbe/reports/taking_care/chapter1.html
“Because we live longer we die differently; and b because medicine di i can better b tt confront f t the th illnesses ill that would kill us quickly, we are far more likely to die after a period of protracted physical disability and cognitive impairment .”
The President’s Council on Bioethics (accessed07/07/2011) http://bioethics.georgetown.edu/pcbe/reports/taking_care/chapter1.html p // g g /p / p / g_ / p
Illness trajectories Illness trajectories
25% of all deaths
20% of all deaths
Adapted from: Lynn J, Adamson DM. Living well at Adapted from: Lynn J Adamson DM Living well at the end of life; adapting health care to serious chronic illness in old age. Arlington, VA, Rand Health, 2003
40% of all deaths
www.eguidelines.co.uk/.../thomas_fig1_jun06.gif
Onset of incurable cancer → time often a few years but decline usually seems 70 yo (178,000 beds) 75% high level care & 25% low level care • 75% high level care & 25% low level care • Female : Male = 2:1 • 55% > 85 yo 55% > 85 yo • 20% > 90 yo • 59% dementia 59% dementia • 27% other mental illness • 14% no mental health diagnosis 14% t l h lth di i AIHW Residential Aged Care in Australia 2008‐2009
Living and dying i in a Residential Aged Care Facility id i l d ili Separations: 88% death 3% return to the community h i 3% discharged to hospital 3% move to other residential aged care 3% other AIHW Residential Aged Care in Australia 2008‐2009 AIHW Residential Aged Care in Australia 2008 2009
Living and dying i in a Residential Aged Care Facility id i l d ili Length of of stay