• H Lane, R D Zordan, T J Weiland, and J Philip.
• Centre for Palliative Care, St Vincent's Hospital and University of Melbourne, Victoria, Australia. heather.lane@svhm.org.au
• Intern Med J. 2013 Feb 1; 43 (2): 144-9.

BackgroundResidents of residential aged care facilities (RACF) are commonly hospitalised towards the end of life. Determining the hospitalisation experiences, including the discussion of goals of treatment, is essential to best plan care including planning for end-of-life care for this population.AimTo document hospital presentation characteristics, course, outcomes and care planning for high-care residents of RACF.MethodsA retrospective review of medical records was conducted for all high-care residents aged >64 years presenting to a metropolitan hospital over a 6-month period.ResultsOne hundred and eighty-six high-care residents of RACF presented to hospital 228 times. Transfer paperwork documented resuscitation status for 49 (21%) presentations, and a medical enduring power of attorney or advanced care plan for 85 (37%). Patients had high rates of comorbidities (average Charlson comorbidity index score = 3), polypharmacy (93%), impaired mobility (89%), impaired cognition (81%) and incontinence (76%). Resuscitation status was documented in 50 (55%) and family discussion in 38 (42%) of 91 admissions exceeding 48 h. Documented family discussion was significantly associated with complications or new events occurring during admission (odds ratio 1.56, 95% confidence interval 1.07-2.26).ConclusionThere were low rates of documentation of resuscitation status or family discussion for this highly vulnerable population. Neither hospitals nor community providers appear to take responsibility for future care planning. Acute hospitals could play a greater role in care planning because discussion around course of illness and goals of treatment may enhance patient management, satisfaction and reduce hospitalisations.© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

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