New CIS research: Palliative care failing older Australians - The Centre for Independent Studies
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New CIS research: Palliative care failing older Australians

cis logo 640x360The health system is failing older Australians who want a better life before death, and to die in better circumstances than are currently delivered, new CIS research finds.

The report, Life Before Death: Improving palliative care for older Australians, outlines that at least 20% of hospitalised patients have needs that would benefit from palliative care, and that of the up to 130,000 Australians who should have received palliative care last year, only around 11% (or 14,300) did.

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“Expanding access to palliative care services in Australia would ensure that patients with incurable chronic conditions receive person-centred and cost-effective care — not only in the terminal stage, but earlier — to improve the quality of their lives in the period well before death,” research author Dr Jessica Borbasi says.

“Palliative care enables people to live at home for longer, prevents hospitalisations and — within hospital — prevents invasive and misdirected medical care that is usually also expensive.

“However, whether Australians receive palliative care is a lottery that currently depends not only on your diagnosis — cancer being ‘preferable’ — but also on your postcode and doctor.

“The average older Australian has four chronic conditions and sees the GP 10 times a year;  using twice as many health resources as the average Australian. Most will die from chronic disease at a very old age with increasing frailty — rather than swiftly from, say, a heart attack at younger ages (as used to be the case).

“The health system has done a stellar job at keeping us alive for longer. But it is in the latter and last years, months, weeks and days of life that it fails older Australians.”

The health system is not set up to deal with the reality of modern death, especially in the last six months of life, Dr Borbasi says. Hence, that time is usually experienced as recurrent health crises or exacerbations, hospital admissions and readmissions, and invasive interventions.

“Then ultimately, this is often followed by an unexpected death in hospital without palliative care — the average total cost of which is in the order of $26, 000 per person for six months of poorly-supported life,” she says.

“However, palliative care is often misunderstood as purely end-of-life care. In fact, palliative care — properly defined — can manage chronic disease symptoms and the depressing end-of-life experience that too many older Australians are currently facing.

“Palliative medicine is driven by patient values and choice, rather than by what doctors dictate. It upholds autonomy and individuality by creating a partnership with patients and provides holistic care by collaborating with patients, families and carers.

Dr Borbasi says the debate about death and dying needs to be broadened beyond the question of where patients die; and focus on how patients live before death.

“Almost 50% of Australians currently die in hospital, and the reality is this is likely to continue,” she says.

“The real problem is not dying in hospital, but death without palliative care.

“The challenge is to ensure that hospitals, GPs, specialists and residential aged care facilities offer greater access to palliative care to improve the quality of life before death for more Australians.”

Dr Jessica Borbasi is a medical doctor, a Research Associate in the Healthcare Innovations Program at the Centre for Independent Studies, and author of the research report Life Before Death: Improving palliative care for older Australians.