Poster Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2025

Palliative care needs of residential aged care facility residents admitted to a Hospital in the Home service (119686)

Angela Zeng 1 , Aaron B Wong 2 3 4 5 , Seok M Lim 2 6
  1. Geriatric Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
  2. Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
  3. Palliative Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
  4. Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
  5. Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  6. RMH@Home Acute, The Royal Melbourne Hospital, Parkville, Victoria, Australia

Aims

Most residential aged care facility (RACF) residents prefer to die in their homes, yet many continue to be hospitalised when unwell. This study aims to identify palliative care needs of RACF residents admitted into a Hospital in the Home (HITH) service in metropolitan Melbourne and evaluate the reasons for presentation and interventions provided.

 

Methods

Retrospective cohort study of palliative care needs of RACF residents admitted into HITH between July to December 2023.

  

Results

There were 142 admissions for 135 patients, with a mean age of 88.2 years. They were predominantly female (55.6%), frail (median Clinical Frailty Score 7), highly comorbid (median Charlson Comorbidity Index 7), and functionally dependent (median Australia-modified Karnofsky Performance Status 30). Dementia or cognitive impairment was present in 75.6%, and 53.3% had delirium at time of referral. Most referrals (80.3%) originated from RACF staff, with 42.3% occurring after hours. The most frequent reason for referral was acute deterioration (74.6%). Palliative care discussions (88.0%) and anticipatory medication provision (75.4%) were the most common interventions. A quarter (25.9%) of patients died in their facility during admission, aligning with their preferred place of care. Specialist palliative care input was sought in 31.7% of admissions, predominantly for care coordination (87.6%). Most (81.5%) patients were deceased within 12 months.

 

Conclusions 

Despite this cohort’s vulnerability and high mortality, gaps were identified in proactive palliative care engagement and community-based service delivery. Future care models must be flexible, responsive, and integrate palliative and supportive care to improve outcomes.