End of life care challenges for older people in sub-acute care.

Abstract

INTRODUCTION: Despite the goals of sub-acute care to optimise patient functioning, many older patients will die in sub-acute care. METHOD: Conducted in an 183-bed sub-acute facility in metropolitan Melbourne, an audit was undertaken of 55 inpatient deaths from July 2015-June 2016. Patient demographics, diagnosis, care goals, care transitions and end of life care management data were collected. All clinician written entries related to the timing, nature and content of communication with next-of-kin; and entries related to care provision and decisions were collected. RESULTS: Numeric data were analysed descriptively. Of the 55 inpatient deaths, 55% were male, and 64% were aged 80 or over. 'Falls', 'Diseases of the circulatory system' and 'Problems related to life-management difficulty' were the top three reasons for admission. 43% also had comorbid diagnosis of cognitive impairment. Almost 48% of patients were admitted for 'Assessment', and 39% to 'Establish a safe discharge destination'. One patient was admitted for management of end-stage disease. Content analysis of the written entries of the multidisciplinary treatment team revealed that when dying patients were able to state their preference for end of life care, care goals were openly communicated and care was more coordinated. In all other cases, the use of vague or evasive language was found to impact communication between clinicians contributing to delays in care processes and decisions; also impacting next-of-kin's understanding and acceptance that the patient was dying. Cultural differences were not consistently accommodated, further compounding end of life care. CONCLUSION: Further work is needed to promote earlier acknowledgement and communication when a patient admitted to sub-acute care is dying rather than requiring rehabilitation; allowing for care plans and processes to be amended accordingly.