rural end-of-life care in new zealand, australia and south east asia rod macleod department of...
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Rural end-of-life care in New Zealand, Australia and South East Asia
Rod MacLeodDepartment of General Practice and
Primary Health Care
University of Auckland and
North Shore Hospice, Takapuna
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The overall trends – not really different ‘down under’ An aging population Increasing life expectancy Rising numbers of the oldest old [Growing burden of non-communicable disease] Changing family structure Shifting patterns of work and retirement Evolving social insurance systems
Department of State and the Department of Health and Human Services. 2007. Why Population Aging Matters: A Global Perspective . Washington DC: National Institutes of Health
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Asia Pacific Hospice Palliative Care Network
600 services throughout the region Vary from comprehensive urban programs to rudimentary
rural ones Over 1000 members from 29 countries Split into 5 regions
East Asia; central Asia; south-east Asia; south Asia; Pacific
www.aphn.org
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Malaysia
Perhaps up to 40% of deaths not registered in Malaysia
Penang General Hospital 1999-2001 Place of death
Home 94 (60%) Penang General Hospital 41 (26%) Nursing homes 13 (8%) Unknown 8 (5%)
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Malaysia
Penang Hospice at home 1992-2005
Place of death Home 1999 (79%) Hospital 515 (20%) Nursing homes 27 (1%)
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Michael Wright with Ednin Hamzah, Temsak Phungrassami and Agnes Bausa-Claudio
Oxford University Press
Hospice and Palliative Care in Southeast Asia
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Australia
Foreman LM, Hunt RW, Luke CG, Roder DM. Factors predictive of preferred place of death in the general population of South Australia. Palliative Medicine 2006; 20: 447-453
2652 respondents aged 15+ if dying of ‘a terminal illness such as cancer or emphysema’
Predictors of preference of preferred home death include younger age, male, born in UK/Ireland or Italy/Greece, better physical health, poorer mental health
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Australia
Place of death2000-2002
% deaths
Actual Preference
Hospital 56.4% 28%
Hospice 17.7% 12.2%
Nursing home 11.7% 1.8%
Home 14.1% 58.1%
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Australia
Currow DC, Burns CM, Abernethy AP Place of death for people with noncancer and cancer illness in South Australia: a population-based survey. Journal of Palliative Care 2008; 24,3, 144-150
9,500 households – 31% had someone close die of a terminal illness in the preceding five years
62% of deceased had accessed palliative care
Palliative care involvement did not reduce institutional deaths
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Table 1 / Place of Death of Deceased Individuals with Non Cancer Illnesses vs those with Cancer
Place of Deathn=1920 (n=352) (n=1569) p-value
Home (n=366) 19.1 15.90% 19.80% 0.09242Hospital (n=1159) 60.4 60.40% 60.30% 0.9686Hospice (n=245) 13.9 8.60% 15.10% 0.0015RACF** (n=128) 6.7 15.00% 4.89% <0.0001Total = 1920* 100 100.00% 100.00%
*Slight variation in numbers due to rounding of weigted sample** Residential Aged Care Facilty
TotalNon Cancer Cancer
Australia
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Table 2 / Place of Death and Use of Pallative Care Services by Cancer and Non Cancer Populations
Use of Palliative Care ServicesYes No Yes No
p - value for non cancer n=153 n=166 n=849 n=456vs cancer <0.0001 48.00% 52.00% 65.00% 35.00%Place of Death p-value p-valueHome (n=323) 13.50% 19.40% 0.1693 20.80% 20.40% 0.8644Hospital (n=949) 51.15% 68.60% 0.0014 51.40% 70.00% <0.0001Hospice (n=267) 18.30% 9.00% <0.0001 22.40% 5.60% <0.0001RACF (n=109) 16.70% 11.40% 0.495 5.40% 3.90% 0.8324p-valueTotal = 1626* 100% 100% 100% 100%
*Slight variation in numbers due to rounding of weigted sample** In 294 responses, use of palliative care services was unknown p-value relfects the two by two shi squared test of location versus palliative care service use p-value reflects chi squared for the trend reflecting the impact of palliative care services on location of death
<0.0001 <0.0001
Australia
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Australia
McNamara B, Rosenwax L Factors affecting place of death in Western Australia Health & Place 2007; 356-367
Almost half of Western Australians died in hospital
With increasing age there is a tendency to die in your place of residence
People accessing specialist palliative care had a seven times higher chance of dying in their usual place of residence
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Australia
26,882 people died in WA in 2.5 year study
48.6% died in hospital 35.8% died in place of residence (private 20.2%; RAC 15.6%) 5.5% died in hospice 6.3% died in some ‘other’ place
McNamara B, Rosenwax L. Factors affecting place of death in Western Australia. Health & Place 2007; 356-367
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Hospice care in NZPatients (total)
In-patient admissions
Community visits (nursing etc)
Average length of stay
2009 11,963 4,479 89,299
2008 13,350 5,073 128,993 8.2 days
2007 10,748 4,586 118,300 9.7 days
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Hospice care in NZ
Place of death
Residential aged care
Home Hospital Hospice Total
2009 1390 (20%)
2261 (33%)
1363 (20%)
1792 (26%)
6916
2008 1926 (24%)
3852 (46%)
1207 (15%)
2044 (25%)
8150
2007 1079 (17%)
2744 (43%)
905 (14%)
1573 (25%)
6301
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Palliative Care Partnership
Stewart B, Allan S, Keane B et al (2006) Palliative Care Partnership: a successful model of primary/secondary integration
New Zealand Medical Journal 119(1242)
http://www.nzma.org.nz/journal/119-1242/2235/
McKinlay E, McBain L (2007) Evaluation of the Palliative Care Partnership: a New Zealand solution to the provision of integrated palliative care
New Zealand Medical Journal 120(1263)
http://www.nzma.org.nz/journal/120-1263/2745/
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