End-Of-Life Care for Older People in Australia - Term Paper Example

End-Of-Life Care for Older People in Australia Name Institution Course Date End of life care for older people in Australia 1. Introduction Quality of life is considered a complex subject that needs to be accessed through subjective and objectives techniques (Valente, 2016). For people in the old age, dying is often a lingering process which has a slow decline and makes it difficult to demarcate patterns of care. Australia is characterized by large number of aging population. Aging population is in return characterized by chronic conditions which require on-going care. In Australia, end-of-life care has been adapted in order to support and care for older people (Advance Care Planning Australia, 2014). This literature review is focussed on end of life care for elderly in Australia. The research study will include the definition of end-of-life care, illustration of older people and end-of-life care and description of dying and death in Australia. In addition, the paper will explain the quality of care for older people at end-of-life and the barriers to end-of-life care. 2. Definition of End-of-Life Care The definition of terms referring to care of people close to dying has transitioned over the years from terminal care to end-of-life care (Curtis et al., 2012). The term end-of-life care has been used as a term referring to palliative care for the needs of people suffering from conditions other than cancer in a long-stay care settings. End-of-life care is not always clear since is termed as a continuum instead of a point in time. According to Curtis et al. (2012), end-of-life care is termed as the chronologically indeterminate life event when a patient and a caregiver struggle with consequences brought about by advanced chronic diseases such as heart disease, strokes as well as multiple co-existing conditions. In addition, according to De Vleminck et al. (2014), end-of-life care is the care sensitive to personal, cultural and spiritual beliefs offered to older people who suffer from progressive life-threatening conditions up to a period of bereavement. Therefore, it is evident that end-of-life care is applicable to individual with different illnesses and involves longer time before death. End-of-life has different meaning from palliative care (Curtis et al., 2012). Palliative care is narrower in focus as it emphasizes on cancer patients and pain relief. However, over the years, it has expanded in meaning and diversification. End-of-life care is aimed at offering the best quality of life for people suffering from chronic diseases together with the family members. The general definition of end-of-life care is the care services offered to meet the needs of people with long-term conditions and illnesses who are near death (Curtis et al., 2012). 3. Older People and End-of-Life Care Since the main purpose of this essay is to illustrate end-of-life care for older people in Australia, it is important to highlight the connection between palliative care and gerontological care (McCaffrey et al., 2013). Palliative care and gerontological care have identical purpose in relation to quality of life promotion, aggressive treatments, self-respect, and community-based models among others. Nevertheless, the two terms have little integration due to the narrow focus of healthcare systems on cure of older people near death. Additionally, policy circles as well as care structures think of aging in positive terms, which influences the discussion on end-of-life issues (Curtis et al., 2012). Death is perceived as a relief instead of human condition which leaves no room for the adoption of end-of-life care. Moreover, death among elderly people is undervalued and is considered a natural phenomenon and on schedule (McCaffrey et al., 2013). How old people are cared for and supported is a representation of wider social values. It has been witnessed in many instances where doctors refuse to treat pain in elderly people especially those with non-malignant illnesses (McCaffrey et al., 2013). Symptom control in old people is often not a priority for reasons like lack of time. The disregard for end-of-life care for elderly people is attributed to the attitude and perception that old people are prepared for death and their death are not as important as those of young people. This perception is able to impact the allocation of resources for end-of-life care schemes of older people. It is also likely to result to poor quality of life for older people and failure to personalize care in the duration leading to death (Curtis et al., 2012). Ageist attitudes to death have also the ability to influence end-of-life care. People are different; some do not mind talking about death while others do. Undoubtedly, no evidence supports the notion that being older makes it is easier to engage in death discussions. Families and staff alike may not be ready to take care of a patient who is dying. It is therefore difficult for these people to be open in discussing end-of-life concerns with older people (McCaffrey et al., 2013). In addition, when care staff and patients have different cultural attitudes to dying, the quality of care is impacted. Foreign care staff in Ireland has increased considerably which may result to different methods of end-of-life care that vary with the wishes of the patients (Horsfall, Noonan and Leonard, 2012). The different values and approaches to end-of-life care for older people should be reconciled through awareness which is part of person-cantered approach to care. The combination of palliative care and gerontological care is required in order to develop a new approach to end-of-life care for elderly people (McCaffrey et al., 2013). This approach should value medical, health as well as psychosocial scopes of caring for older people at end-of-life. Being administered to long-stay care settings represents a major transition in an old individual’s life. A large percentage of people in long-stay care settings end up dying there. There are three stages involved in end-of-life care; the living and losses in the long-stay settings; the actual death; and the bereavement after death. With regard to these stages, both palliative care and gerontological care are inadequate (McCaffrey et al., 2013). End-of-life should be made the key concept of care offered from admission to bereavement. End-of-life care should be a longer perspective and should focus on quality of life of both the patient and their families. 4. Dying and Death in Australia In Australia, in 2014, there were about 153,580 deaths which was an increase of 5,902 compared to 2013. In the statistic, 2 in 3 deaths involved people with 75 years and above (Australia Bureau of Statistics, 2013). 51 per cent of death registered in the country that took place during 2011and 2012 involved people receiving palliative care from hospital. In 2014, the majority of deaths amounting to 78,341 involved male and 75,239 involved female deaths. The major causes of death were reported to be ischaemic heart disease, stokes, chronic respiratory diseases, dementia and cancer of the lung and trachea among others. These diseases accounted for more than a third of all reported deaths (Australia Bureau of Statistics, 2013). Even though the leading causes of deaths were identical for both the males and females, there were some differences between sexes. Regarding ischaemic heart diseases, 11,082 males compared to 9,091 female died in 2014. Cancer of trachea and lung led to death of 4,947 males compared to 3,304 females (Australia Bureau of Statistics, 2013). More females (7,859) died from dementia than males (4,106) and also about 6,486 females died from cerebrovascular diseases compared to 4,279 males. With advancement in technology and advances in medicine, Australians are not living longer. People in the country are now less likely to die because of stoke or dementia or other diseases. In the past, sick people especially the elderly were cared at home where many of them died there (Australia Bureau of Statistics, 2013). Today, old people suffering from serious illnesses are cared in long-stay care facilities and hospitals. 5. Quality of Care for Older People at End-of-Life Over the years, national as well as international policy organizations have illustrated their concern for outlining and assessing quality of care at end-of-life. The quality of care at end-of-life involves the care of dying people as well as their families and friends. Wolf and Wolf (2013) have illustrated the theoretical framework for outlining and assessing the quality of care. The theoretical framework accentuates structure and process that can be applicable to end-of-life in various terms. For instance, the structure of care is based on staffing and the process of care is concerned with how appropriate the care is, and how timely it is (Murtagh et al., 2014). Other issues in the process term include advance care planning and ratio of staff to patients. The measuring of quality of care is a sensitive and complex area. According to the United States of Institute of Medicine, there are six elements that can be utilized to assess the quality of care at end-of-life (Murtagh et al., 2014). These elements include quality of life, physical well-being, psychosocial well-being, spiritual functioning, patient perception of care and family well-being and perception. Quality of care for older people should ensure that deaths are meaningful, pain-free and peaceful. Older people should face death in a way that they are ware of their conditions and accept it (Murtagh et al., 2014). Friends and families of dying patients should not be neglected but should be communicated to openly and should be accommodated in the end-of-life care. 6. Barriers to End-of-life Care Continuity of Care One of the major challenges of end-of-life care is the fact that care is fragmented in a way that patients are required to transition in many ways in their care and there are multiple providers for the care (Robinson et al., 2011). As a result, often than not, there is lack of continuity and poor communication between staff in critical hospitals and in long-stay care setting is experienced. In addition, patients may undergo unforeseen transfer from home to hospital at the end-of-life which may result to discontinuities with regard to care provision. The change in setting may be troublesome to older patients and may result to deterioration in their condition (Robinson et al., 2011). End-of-life care should be in a continuous state with open communication between different staff and constant transition of patients. Education and Training Lack of proper end-of-life care education and training among staff may affect the quality of care. If caregivers in end-of-life care are not properly educated and trained, they may be limited to offer physical care including pain and symptom management (Robinson et al., 2011). Without effective education, caregivers may be unable to communicate well with patients in relation to their prognosis. In addition, training of managers is necessary since they have a huge impact on the quality care. There is a need to train managers and staff in palliative care in order to improve quality care at end-of-life (Silvester, et. Al., 2013). Since care assistants have more contact with patients at end-of-life, they need to undergo short courses in end-of-life care. Offering training and education in end-of-life care to caregivers and other staff in long-stay care settings is necessary in offering good quality care. In order to offer effective end-of-life care, there is need to educate and train staff, caregivers, care assistants and managers. Lack of such training impedes good quality care (Robinson et al., 2011). Cultural Awareness Another barrier to end-of-life care is lack of cultural awareness among staff. Most often, old people who are dying tend to have different cultural beliefs from care assistants (Coolen, 2012). Lack of accommodation of different cultural beliefs of patients can deter the experience of patients. In the recent years, Australia has grown to become one of the countries with different culture groups. And due to this quality care facilities are faced with cultural challenges. Therefore, in order to overcome this, staff and managers need to be trained in cultural awareness of different beliefs about death and dying (Coolen, 2012). Lack of understanding of end-of-life care and accommodation of different cultural beliefs revolving around death and dying may result to confusion and disparities in provision of quality care (Silvester, et. Al., 2013). Spiritual and Psychological Support Spiritual care is very paramount enabler of end-of-life care for older patients. According to a research study on spiritual care conducted in Australia, there are several barriers to delivery of spiritual care (Silverster, 2012). Lack of inadequate staff, lack of awareness and education, and lack of emphasis on physical care are among the limitations to the delivery of effective spiritual care. In addition, lack of psychological support for patients act as a barrier to end-of-life care. Nevertheless, there has been inadequate research on the area of psychological needs of older patients. Older people are admitted to long-stay care facilities having gone through life difficulties such as bereavement, loss of finances and loss of physical function (National Institute on Aging, 2016). In addition, in the facilities, these patients can become attached to other patients whose death can be very difficult to overcome. Research has suggested that there are limited formal psychological services in Australia. As a result, quality care provision has been found to be low (Silvester, et. Al., 2013). Communication Among the objectives of good quality of care in end-of-life is to assist patients understand the process of dying and offering them a sense of control by having open awareness of death and dying (Silverster, 2012). Open awareness entails a process where the staff acknowledges the likelihood of patient’s death and gives the patients a chance to discuss their distress and make plans. In Australia, it has been reported that there is ethos of closed awareness among staff that may be detrimental to provision of quality care (Broom et al., 2014). Outward signs of death among older people are hidden from the patient and staff often assures the patients of their recovery. This may be a barrier to offering high quality end-of-life care. However, although open awareness is applicable to many situations, it may be inappropriate to some older people at end-of-life care (Broom et al., 2014). Poor communication between staff and patients inhibit the platform for patients to plan the type of care they would love. Additionally, families of patients may not be told about the real conditions of their relatives and may be unable to say good-bye to their relatives when their time comes (Broom et al., 2014). Lack of communication is brought about by many factors. For instance, older patients in the long-stay care facilities with not have predictable trajectory which makes it difficult for staff to identify the real condition of the patients who are dying until it is too late to make any plans. Even in situations where the staff is able to assess that a person is dying, they may not communicate the bad news to the patients in order to protect them from the impacts of the information. They may also feel uncomfortable themselves to discuss death subject (Broom et al., 2014). Advance care planning with older people should be incorporated in order to ensure that their wishes are followed from admission to their death. Research has shown that although advance care planning has been incorporated in many countries, very few patients make plans and when they do, doctors may not always follow them. In order to ensure there is good relationship between patients and staff and that the wishes of the dying patients are followed, good communication must be developed in the long-stay care facilities and hospitals (Broom et al., 2014). 7. Recommendations In order improve the end-of-life care for older people, the hospice movement was established. In countries like the United Kingdom and Australia, some funds have been set aside to develop models of best practice (Broad et al., 2013). There are various ways to improve the end-of-life care for older people. For instance, introduction of educational and training programs among medical staff can be a great way to ensure good quality care for older people. Australia should come up with a framework that emphasizes on continuity, communication and coordination of care in order to enhance provision of end-of-life care for older people. Such framework can enable the identification of patients in need of end-of-life care, the assessment of their needs and planning and communication across the entire care process (Broad et al., 2013). End-of life care should not be neglected as a result of perception that death among older people is natural (Broom et al., 2014). End-of-life care is an ethical undertaking that ensures the rights of older people are protected. Therefore, Australian government should be more committed to developing programmes that support palliative care and end-of-life care among older people. More funding should be allocated to research, education and training and provision of quality care (Broom et al., 2014). In addition, sensitive conversations around end-of-life care and death should be developed among medical staff, patients and families in order to achieve greater chance of gratifying the wishes and needs of the dying patients. 8. Conclusion In conclusion, end-of-life care is a very sensitive issue particularly among older people. Due to the attitudes and perceptions that death among older people is naturally, quality of life among older people is ignored. Australia is considered an aging society with large number of old people. Therefore, there is a need to provide good quality care for these people before their death. However, there are so many barriers to effective end-of-life care such as lack of communication between staff and patients and their families, lack of cultural awareness, lack of spiritual and psychological support among patients and lack of education and training among care assistants and entire care staff. In order to improve end-of-life care of older people, there is need for some initiatives that supports the provision of quality of life. However, these initiatives are inadequate on their own. 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