Rural end-of-life care in New Zealand, Australia and South East Asia Rod MacLeod Department of General Practice and Primary Health Care University of Auckland.

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

[email protected]

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

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

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%)

Malaysia

Penang Hospice at home 1992-2005

Place of death Home 1999 (79%) Hospital 515 (20%) Nursing homes 27 (1%)

Michael Wright with Ednin Hamzah, Temsak Phungrassami and Agnes Bausa-Claudio

Oxford University Press

Hospice and Palliative Care in Southeast Asia

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

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%

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

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

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

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

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

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

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

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/