End-of-life care for aged care residents presenting to emergency departments

Background: The number of patients from Aged Care presenting to acute care is increasing, many of whom have a life limiting illness.

Aims: To identify differences in relation to Aged Care Residents presenting to Emergency departments who died during a hospital admission compared to those who were referred to the hospital based palliative care.

Methods: Review of a stratified random sample of 90 Aged Care residents transferred to acute care who died during admission in 2009; half the sample received palliative care. Comparisons were made with regard to age; gender; co-morbidities; symptoms, investigations and active treatment; prior admissions and costs.

Results: The median age of patients was 87.5 years, 61% were female and 38% had three or more admissions in the year prior to death. Patients with a length of stay of four or more days were 2.98 times (CI, 95%:1.11-8.03) and patients with agitation were 3.08 (CI 95%:1.10- 8.64) times more likely to be referred to palliative care. Patients who received palliative care had significantly fewer investigations or active treatment in the 24 hours prior to their death (p< 0.01) and palliated patients had significantly lower average costs per day of admission ($1022, SD=$441) compared to those who were not palliated ($ 831; SD= $ 1041) (p< 0.001).

Discussion: Our study indicates there is a difference between dying patients who received palliative care compared to those who did not in an acute care setting. Further research into the outcomes of patients discharged back to Aged Care facilities for palliative care warrants investigation.