The AIHW has released their latest report, providing important insights into how older individuals who are accessing aged care and who have a life limiting condition, receive care as they approach the end of life.
Current national reporting provides only a limited view, particularly of the timing and setting of palliative care delivery. As Australia’s population ages, there is an increasing need to ensure that aged care and palliative care services are accessible, effective, and responsive to the complex needs of older people.
This latest report uses linked data – aged care, public hospitals, Medicare-subsidised services and mortality – from the National Health Data Hub (NHDH) to examine variations in receipt of specialist palliative care for older people accessing aged care during the last year of life. It compares older people living in residential aged care with older people living in the community and using home care (now Support at Home) or residential respite care.
Key Findings (taken directly from the report)
In 2021–22, there were 132,000 people aged 65 and over who died from predictable deaths (not sudden deaths). Of these people:
- the median age at death was 85 years
- over half (56%) used at least one aged care service in the last year of life (41% were living in residential aged care, 10% were living in the community using home care and 5.3% were using residential respite care)
- organ failure (47%) was the most common end-of-life disease trajectory, and of these almost 9 in 10 (88%) died from heart disease or stroke
- 1 in 3 (33%) died from cancer, and people living in residential aged care were less likely to die from cancer compared with people in other settings
- more than 1 in 10 (11%) followed a frailty and dementia trajectory, and this is 2.4 times as common for people living in residential aged care
- almost 2 in 5 (38%) received specialist palliative care in the last year of life
Receipt of specialist palliative care was higher among the younger age groups (50% of people aged 65–74) and people who died from cancer (60%).
Cancer patients were most likely to receive specialist palliative care (60%), followed by people who followed the organ failure trajectory (28%) and people who followed the dementia and frailty trajectory (22%). For all disease trajectories, people using home care and residential respite care were at least twice as likely to receive specialist palliative care compared with people living in residential aged care*.
The first specialist palliative care service in the last year of life usually occurred in the last two weeks of life (median of 12 days before death).
Just over 2 in 3 (68%) people in the study population (aged 65 and over) had an unplanned hospital admission in the last year of life. People living in residential aged care were less likely to have an unplanned hospital admission in the last year of life compared with people using home care and residential respite care or people not receiving any of the selected aged care services. Unplanned hospital visits in the last year of life, and especially in the final 2 weeks, are widely used as indicators of end–of–life care quality and health system performance and may indicate gaps in symptom management or advance care planning.
People who received specialist palliative care in the defined aged care settings were more likely to have unplanned hospital admissions in the last year of life compared with people who did not receive specialist palliative care (87% and 56%, respectively). It is important to note that people receiving specialist palliative care often have advanced, complex illnesses, increasing their need for urgent medical attention to respond to the severity of their condition, rapid symptom deterioration or complications.
Among the 132,000 people in the study population, 48% were admitted to a public hospital in the last 4 weeks of life. Of these 75% died in hospital, 14% returned to their usual place of residence, 6.4% were transferred to residential aged care, 4.7% were transferred to another setting (which may include private hospitals).
At the time of death, 40% of the study population were in hospital (including emergency departments) and 36% were in residential aged care. Place of death offers insights into the settings of where end-of-life care was delivered, in lieu of measuring personal preferences.
People living in residential aged care in the last year of life, compared with people using home care and residential respite care, were less likely to:
- receive specialist palliative care (21% compared with 49%)
- receive their first specialist palliative care service earlier (8 days before death compared with 13 days)
- have an unplanned hospital admission in the last year of life (58% compared with 81%)
- be in hospital (including emergency departments) at the time of death (17% compared with 50%).
The AIHW notes that the report does not capture all palliative care activity in Australia, due to data limitations. It excludes palliative care provided in residential aged care such as non-specialist palliative care provided by care workers or nurses because these services are not identified in national administrative data collections. It also excludes private hospitals, and some community-based palliative care services.
View the full and detailed report here
* The higher rates of specialist palliative care among cancer patients reflect the traditionally strong association between palliative care and cancer diagnoses. Cancer patients often experience a more predictable illness trajectory, with a rapid progression to a shorter terminal phase, during which they are typically at home, in hospital, or receiving care in specialist palliative units.
In contrast, individuals with dementia and other chronic conditions follow a slow, prolonged, and unpredictable decline. People living in residential aged care are less likely to have cancer, and more likely to have conditions such as frailty or dementia (AIHW 2025). As a result, the need for palliative care may be less readily recognised in residential aged care settings, contributing to lower access to specialist palliative care (Quinn et al. 2021, Murray et al, 2005).