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Background <p>Although the majority of those living in residential aged care facilities (RACFs) prefer to remain in their facility if their health deteriorates, many do not end up achieving this. Hospital-in-the-home (HITH) services have been increasingly used to support RACFs by providing acute, palliative, and supportive care to residents on-site. Understanding the reasons for RACFs engaging HITH services can help identify unmet needs and guide improvements in community-based end-of-life care. This study aimed to characterise the palliative care needs of RACF residents admitted to an Australian HITH service and describe the resources and interventions provided to meet these needs.</p> Methods <p>A single-centre retrospective cohort study was conducted at a large metropolitan hospital in Melbourne, Australia. We included RACF residents with palliative care needs admitted to this hospital’s HITH service between July and December 2023. Data were extracted from electronic health records and analysed using descriptive statistics.</p> Results <p>There were 142 separate admissions for 135 patients. The patient cohort had a mean age of 88.2 years, 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 referral. Most referrals (80.3%) originated from RACFs, with 42.3% occurring after-hours. The most frequent referral reason was for acute deterioration (74.6%). Over a quarter (28.9%) of patients had three or more concurrent symptoms at time of referral. The most common interventions included palliative care discussions (88.0%) and anticipatory medication charting and provision (75.4%). A quarter (25.9%) died in their RACF during admission, which was aligned with their location of choice. Specialist palliative care input was sought in 31.7% of cases, predominantly for care coordination (87.6%). Most (81.5%) of this cohort were deceased within 12 months.</p> Conclusions <p>This study highlights key gaps in care delivery for RACF residents with palliative care needs and how HITH can support care in this setting. Flexible and responsive models that integrate palliative care with limited active treatment are required to support goal-aligned care and improve palliative outcomes for this vulnerable population.</p>

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Palliative care needs among residential aged care facility residents referred to an Australian hospital-in-the-home service: a descriptive retrospective cohort study

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  • 发表日期：

    2026年3月2日

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  • Angela Zeng,
  • Aaron B. Wong,
  • Seok M. Lim

摘要

Background

Although the majority of those living in residential aged care facilities (RACFs) prefer to remain in their facility if their health deteriorates, many do not end up achieving this. Hospital-in-the-home (HITH) services have been increasingly used to support RACFs by providing acute, palliative, and supportive care to residents on-site. Understanding the reasons for RACFs engaging HITH services can help identify unmet needs and guide improvements in community-based end-of-life care. This study aimed to characterise the palliative care needs of RACF residents admitted to an Australian HITH service and describe the resources and interventions provided to meet these needs.

Methods

A single-centre retrospective cohort study was conducted at a large metropolitan hospital in Melbourne, Australia. We included RACF residents with palliative care needs admitted to this hospital’s HITH service between July and December 2023. Data were extracted from electronic health records and analysed using descriptive statistics.

Results

There were 142 separate admissions for 135 patients. The patient cohort had a mean age of 88.2 years, 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 referral. Most referrals (80.3%) originated from RACFs, with 42.3% occurring after-hours. The most frequent referral reason was for acute deterioration (74.6%). Over a quarter (28.9%) of patients had three or more concurrent symptoms at time of referral. The most common interventions included palliative care discussions (88.0%) and anticipatory medication charting and provision (75.4%). A quarter (25.9%) died in their RACF during admission, which was aligned with their location of choice. Specialist palliative care input was sought in 31.7% of cases, predominantly for care coordination (87.6%). Most (81.5%) of this cohort were deceased within 12 months.

Conclusions

This study highlights key gaps in care delivery for RACF residents with palliative care needs and how HITH can support care in this setting. Flexible and responsive models that integrate palliative care with limited active treatment are required to support goal-aligned care and improve palliative outcomes for this vulnerable population.