Estimating potential palliative care needs for residential aged care: A population‐based retrospective cohort study

Abstract

AbstractObjectivePopulation‐based data on the required needs for palliative care in residential aged care have been highlighted as a key information gap. This study aimed to provide a comprehensive estimate of palliative care needs among Australia's residential aged care population using a validated algorithm based on causes of death.MethodsA population‐based retrospective cohort study was conducted using data from the Registry of Senior Australians of non‐Indigenous residents of residential aged care services in New South Wales, Victoria, and South Australia aged older than 65 years, who died between 2016 and 2017 (n = 71,677). An internationally validated algorithm was used to estimate and characterise potential palliative care needs based on causes of death. This estimate was compared to palliative care needs identified from funding‐based care needs assessment data.ResultsNinety two per cent (n = 65,949) were estimated to have had potential palliative care needs prior to their death. Of these, 19% (n = 12,467) were assigned an end‐of‐life trajectory related to cancer, 61% (n = 40,511) to organ failure and 20% (n = 12,971) to frailty and dementia. By comparison, only 6% (n = 4430) of residents were assessed as needing palliative care by the funding‐based care needs assessment.ConclusionsOver 90% of individuals dying in residential aged care may have benefited from a palliative approach to care. This need is substantially underestimated by the funding‐based care needs assessment, which utilises a narrow definition of palliative care when death is imminent. There is a clear imperative to distinguish between palliative and end‐of‐life care needs within residential aged care to ensure appropriate and equitable access to palliative care.